Provider Demographics
NPI:1265538367
Name:DAVID S. FERRY III, DDS & KELLEY L. BORDERS, DMD, PL
Entity type:Organization
Organization Name:DAVID S. FERRY III, DDS & KELLEY L. BORDERS, DMD, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BORDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-754-2605
Mailing Address - Street 1:1805 W REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-4739
Mailing Address - Country:US
Mailing Address - Phone:813-754-2605
Mailing Address - Fax:813-752-7436
Practice Address - Street 1:1805 W REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4739
Practice Address - Country:US
Practice Address - Phone:813-754-2605
Practice Address - Fax:813-752-7436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 7245122300000X
FLDN 16284122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty