Provider Demographics
NPI:1821499724
Name:BORGES, GUSTAVO (DDS)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:
Last Name:BORGES
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 1:14941 SW 301ST TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-3767
Mailing Address - Country:US
Mailing Address - Phone:305-767-5540
Mailing Address - Fax:
Practice Address - Street 1:14941 SW 301ST TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-3767
Practice Address - Country:US
Practice Address - Phone:305-767-5540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-14716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist