Provider Demographics
NPI:1801902978
Name:BORDER, WILLIAM ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:BORDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:IN
Mailing Address - Zip Code:47944-1192
Mailing Address - Country:US
Mailing Address - Phone:765-884-0740
Mailing Address - Fax:765-884-9046
Practice Address - Street 1:809 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:FOWLER
Practice Address - State:IN
Practice Address - Zip Code:47944-1192
Practice Address - Country:US
Practice Address - Phone:765-884-0740
Practice Address - Fax:765-884-9046
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12005799A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist