Provider Demographics
NPI:1376522722
Name:BORDLEMAY, JUSTIN WILLIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:WILLIAM
Last Name:BORDLEMAY
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:PO BOX 1885
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-1885
Mailing Address - Country:US
Mailing Address - Phone:706-627-5358
Mailing Address - Fax:912-445-0738
Practice Address - Street 1:10055 FORD AVE STE 3C
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3972
Practice Address - Country:US
Practice Address - Phone:912-445-5311
Practice Address - Fax:912-445-0738
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0138411223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty