Provider Demographics
NPI:1831210699
Name:BORDEN, ELLIOT S (DMD)
Entity type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:S
Last Name:BORDEN
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 1:1404 KYNETON RD
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-1916
Mailing Address - Country:US
Mailing Address - Phone:610-527-0747
Mailing Address - Fax:610-525-1018
Practice Address - Street 1:1050 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2853
Practice Address - Country:US
Practice Address - Phone:610-543-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS17400L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics