Provider Demographics
NPI:1851453401
Name:BORODATY, BRIAN ARTHUR (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ARTHUR
Last Name:BORODATY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BELLEVUE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15229-2125
Mailing Address - Country:US
Mailing Address - Phone:412-931-7900
Mailing Address - Fax:412-931-4111
Practice Address - Street 1:101 BELLVUE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15229-2132
Practice Address - Country:US
Practice Address - Phone:412-931-7900
Practice Address - Fax:412-931-4111
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030594L1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1467459OtherUCCI