Provider Demographics
NPI:1629149752
Name:BORELLO, JOHN STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEVEN
Last Name:BORELLO
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 1:45 S PARK BLVD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6280
Mailing Address - Country:US
Mailing Address - Phone:630-469-6609
Mailing Address - Fax:630-942-0467
Practice Address - Street 1:45 S PARK BLVD
Practice Address - Street 2:SUITE 222
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6280
Practice Address - Country:US
Practice Address - Phone:630-469-6609
Practice Address - Fax:630-942-0467
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics