Provider Demographics
NPI:1578566881
Name:BORIO, EDWARD ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ANTHONY
Last Name:BORIO
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 1:50 W BIG BEAVER RD
Mailing Address - Street 2:STE 100B
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3917
Mailing Address - Country:US
Mailing Address - Phone:248-644-1955
Mailing Address - Fax:248-644-0060
Practice Address - Street 1:50 W BIG BEAVER RD
Practice Address - Street 2:STE 100B
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-3917
Practice Address - Country:US
Practice Address - Phone:248-644-1955
Practice Address - Fax:248-644-0060
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist