Provider Demographics
NPI:1194848481
Name:BORUCHOW, SHELDON MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:MARK
Last Name:BORUCHOW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 EAGLEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1828
Mailing Address - Country:US
Mailing Address - Phone:610-666-6045
Mailing Address - Fax:610-666-8585
Practice Address - Street 1:2901 EAGLEVILLE RD
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:PA
Practice Address - Zip Code:19403-1828
Practice Address - Country:US
Practice Address - Phone:610-666-6045
Practice Address - Fax:610-666-8585
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019398L122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice