Provider Demographics
NPI:1548391808
Name:BORQUEZ, RICHARD G (DDS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:G
Last Name:BORQUEZ
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 1:911 HAMPSHIRE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WESTLAKE VLG
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2818
Mailing Address - Country:US
Mailing Address - Phone:805-277-0606
Mailing Address - Fax:805-253-1940
Practice Address - Street 1:911 HAMPSHIRE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WESTLAKE VLG
Practice Address - State:CA
Practice Address - Zip Code:91361-2818
Practice Address - Country:US
Practice Address - Phone:805-277-0606
Practice Address - Fax:805-253-1940
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA277311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice