Provider Demographics
NPI:1669511754
Name:BOREK, THOMAS J (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:BOREK
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:PO BOX 929
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077
Mailing Address - Country:US
Mailing Address - Phone:413-569-1246
Mailing Address - Fax:413-569-1244
Practice Address - Street 1:603 COLLEGE HIGHWAY
Practice Address - Street 2:
Practice Address - City:SOUTHWICK
Practice Address - State:MA
Practice Address - Zip Code:01077
Practice Address - Country:US
Practice Address - Phone:413-569-1246
Practice Address - Fax:413-569-1244
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA128801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice