Provider Demographics
NPI:1275598237
Name:BORDERS, RICHARD EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EDWARD
Last Name:BORDERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 BRAVE RIFLES REGIMENT ROAD
Mailing Address - Street 2:HQS US ARMY DENTAL ACTIVITY
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121
Mailing Address - Country:US
Mailing Address - Phone:502-624-6158
Mailing Address - Fax:
Practice Address - Street 1:2724 BRAVE RIFLES REGIMENT ROAD
Practice Address - Street 2:HQS US ARMY DENTAL ACTIVITY
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121
Practice Address - Country:US
Practice Address - Phone:502-624-6158
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00095551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0009555OtherGENERAL DENTIST