Provider Demographics
NPI:1750460465
Name:BORBON, YOLANDA IBARRETA (DDS)
Entity Type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:IBARRETA
Last Name:BORBON
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 1:217 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-5314
Mailing Address - Country:US
Mailing Address - Phone:860-437-8493
Mailing Address - Fax:860-437-8521
Practice Address - Street 1:217 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5314
Practice Address - Country:US
Practice Address - Phone:860-437-8493
Practice Address - Fax:860-437-8521
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0089881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice