Provider Demographics
NPI:1346211695
Name:BORDEAUX, DAVID H DOGGETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H DOGGETT
Last Name:BORDEAUX
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 1:914 ADAIR AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-3806
Mailing Address - Country:US
Mailing Address - Phone:404-875-3050
Mailing Address - Fax:
Practice Address - Street 1:855 JUNIPER ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1364
Practice Address - Country:US
Practice Address - Phone:404-249-1716
Practice Address - Fax:404-249-8057
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA92251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice