Provider Demographics
NPI:1437801529
Name:BORRERO DENTAL CORP
Entity Type:Organization
Organization Name:BORRERO DENTAL CORP
Other - Org Name:KIDS HOPE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BORRERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-832-5800
Mailing Address - Street 1:569 W LOWELL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3084
Mailing Address - Country:US
Mailing Address - Phone:209-832-5800
Mailing Address - Fax:209-832-5800
Practice Address - Street 1:569 W LOWELL AVE STE 200
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3084
Practice Address - Country:US
Practice Address - Phone:209-832-5800
Practice Address - Fax:209-832-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty