Provider Demographics
NPI:1891187993
Name:BORIA, DONNA JEAN (RDH)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:BORIA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28374 COUNTY ROAD 317
Mailing Address - Street 2:BOX 4040
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-9158
Mailing Address - Country:US
Mailing Address - Phone:719-395-9048
Mailing Address - Fax:719-395-9064
Practice Address - Street 1:28374 COUNTY ROAD 317
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-9158
Practice Address - Country:US
Practice Address - Phone:719-395-9048
Practice Address - Fax:719-395-9064
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH000201412124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist