Provider Demographics
NPI:1205838356
Name:BORDONARO, FRANK THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:THOMAS
Last Name:BORDONARO
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 1:15247 11TH ST
Mailing Address - Street 2:STE 300
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3727
Mailing Address - Country:US
Mailing Address - Phone:760-245-1049
Mailing Address - Fax:760-245-5501
Practice Address - Street 1:15247 11TH ST
Practice Address - Street 2:STE 300
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3727
Practice Address - Country:US
Practice Address - Phone:760-245-1049
Practice Address - Fax:760-245-5501
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice