Provider Demographics
NPI:1942626833
Name:BORDONARO, DYLAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:
Last Name:BORDONARO
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 1:9645 WASHINGTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-2174
Mailing Address - Country:US
Mailing Address - Phone:303-455-3313
Mailing Address - Fax:888-580-6052
Practice Address - Street 1:9645 WASHINGTON ST STE 100
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2174
Practice Address - Country:US
Practice Address - Phone:303-455-3313
Practice Address - Fax:303-455-3313
Is Sole Proprietor?:No
Enumeration Date:2014-03-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0387721223P0221X
CODEN.002028401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODEN.00202840OtherDENTAL LICENSE