Provider Demographics
NPI:1427179498
Name:BORDONARO, DAVID N (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:N
Last Name:BORDONARO
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 1:123 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3758
Mailing Address - Country:US
Mailing Address - Phone:610-434-9660
Mailing Address - Fax:610-434-1167
Practice Address - Street 1:123 N 13TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3758
Practice Address - Country:US
Practice Address - Phone:610-434-9660
Practice Address - Fax:610-434-1167
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023638L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice