Provider Demographics
NPI:1164952529
Name:BORAK, MEGAN ROSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:ROSE
Last Name:BORAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15424 FM 1825 STE 120
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3148
Mailing Address - Country:US
Mailing Address - Phone:512-989-3300
Mailing Address - Fax:512-989-3331
Practice Address - Street 1:15424 FM 1825 STE 120
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3148
Practice Address - Country:US
Practice Address - Phone:512-989-3300
Practice Address - Fax:512-989-3331
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice