Provider Demographics
NPI:1255063772
Name:BORIE, KEVIN T (DMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:T
Last Name:BORIE
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 1:300 S BISCAYNE BLVD APT 2416
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-5334
Mailing Address - Country:US
Mailing Address - Phone:205-937-9733
Mailing Address - Fax:
Practice Address - Street 1:1348 E HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4241
Practice Address - Country:US
Practice Address - Phone:954-719-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist