Provider Demographics
NPI:1891884201
Name:BORKER, GARY I (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:I
Last Name:BORKER
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 1:1139 RARITAN RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1344
Mailing Address - Country:US
Mailing Address - Phone:732-381-5550
Mailing Address - Fax:732-381-6734
Practice Address - Street 1:1139 RARITAN RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1344
Practice Address - Country:US
Practice Address - Phone:732-381-5550
Practice Address - Fax:732-381-6734
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0174491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice