Provider Demographics
NPI:1649534819
Name:BORDEN, ANJULI NICOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANJULI
Middle Name:NICOLE
Last Name:BORDEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 RIDGELINE DR
Mailing Address - Street 2:112
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3953
Mailing Address - Country:US
Mailing Address - Phone:719-344-8616
Mailing Address - Fax:719-344-8702
Practice Address - Street 1:11550 RIDGELINE DR
Practice Address - Street 2:112
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-3953
Practice Address - Country:US
Practice Address - Phone:719-344-8616
Practice Address - Fax:719-344-8702
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO107581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice