Provider Demographics
NPI:1841642360
Name:MIGUEL FERNANDO BORDA, P.A.
Entity type:Organization
Organization Name:MIGUEL FERNANDO BORDA, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:BORDA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-733-9099
Mailing Address - Street 1:3500 N STATE ROAD 7
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5600
Mailing Address - Country:US
Mailing Address - Phone:561-733-9099
Mailing Address - Fax:
Practice Address - Street 1:1825 FOREST HILL BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-8902
Practice Address - Country:US
Practice Address - Phone:561-733-9099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN199241223G0001X
FLDN194691223G0001X
FLDN164821223G0001X
FLDN195261223G0001X
FLDN213931223G0001X
FLDN209091223G0001X
FLDN194701223G0001X
FLDN191601223X0400X
FLDN193921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty