Provider Demographics
NPI:1881043628
Name:BORROK, MARTIN JR (DMD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:BORROK
Suffix:JR
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 1:16982 STATE HIGHWAY DD
Mailing Address - Street 2:
Mailing Address - City:NOVINGER
Mailing Address - State:MO
Mailing Address - Zip Code:63559-2607
Mailing Address - Country:US
Mailing Address - Phone:660-341-4236
Mailing Address - Fax:
Practice Address - Street 1:1310 CROWN DR
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-2526
Practice Address - Country:US
Practice Address - Phone:660-341-4236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO11521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist