Provider Demographics
NPI:1952393167
Name:BORDERS, THOMAS W (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:BORDERS
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 1:5803 YOUREE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4243
Mailing Address - Country:US
Mailing Address - Phone:318-868-0535
Mailing Address - Fax:318-868-0572
Practice Address - Street 1:5803 YOUREE DR
Practice Address - Street 2:SUITE C
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4243
Practice Address - Country:US
Practice Address - Phone:318-868-0535
Practice Address - Fax:318-868-0572
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA27781223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics