Provider Demographics
NPI:1295999324
Name:ZEPEDA, BORIS M (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:BORIS
Middle Name:M
Last Name:ZEPEDA
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CALLE DE DIEGO ESTE
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-652-3502
Mailing Address - Fax:787-652-4306
Practice Address - Street 1:117 CALLE DE DIEGO E
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-5028
Practice Address - Country:US
Practice Address - Phone:787-652-3502
Practice Address - Fax:787-652-4306
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN160971223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics