Provider Demographics
NPI:1578789368
Name:BORN, PHILLIP E JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:E
Last Name:BORN
Suffix:JR
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 1:2205 S SOLANO DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5503
Mailing Address - Country:US
Mailing Address - Phone:505-522-7320
Mailing Address - Fax:505-522-6395
Practice Address - Street 1:2205 S SOLANO DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5503
Practice Address - Country:US
Practice Address - Phone:505-522-7320
Practice Address - Fax:505-522-6395
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM15181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice