Provider Demographics
NPI:1912126509
Name:BORGES-SCHOCKER, MICAELLA QUEIROZ (DMD)
Entity Type:Individual
Prefix:MRS
First Name:MICAELLA
Middle Name:QUEIROZ
Last Name:BORGES-SCHOCKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HOWE CT
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1783
Mailing Address - Country:US
Mailing Address - Phone:610-399-0821
Mailing Address - Fax:
Practice Address - Street 1:780 W LANCASTER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3415
Practice Address - Country:US
Practice Address - Phone:610-527-2434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0302521223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry