Provider Demographics
NPI:1376643270
Name:BORG, MELVIN B (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:B
Last Name:BORG
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 1:39 CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4041
Mailing Address - Country:US
Mailing Address - Phone:845-634-9699
Mailing Address - Fax:
Practice Address - Street 1:39 CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4041
Practice Address - Country:US
Practice Address - Phone:845-634-9699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics