Provider Demographics
NPI:1700047362
Name:BORELLO, CLARE ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARE
Middle Name:ELIZABETH
Last Name:BORELLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 W CLAY ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2540
Mailing Address - Country:US
Mailing Address - Phone:636-724-2044
Mailing Address - Fax:
Practice Address - Street 1:2745 W CLAY ST
Practice Address - Street 2:SUITE E
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2540
Practice Address - Country:US
Practice Address - Phone:636-724-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080159431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice