Provider Demographics
NPI:1952962094
Name:BORUM, ROBERT COVINGTON III (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:COVINGTON
Last Name:BORUM
Suffix:III
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 1:122 ARSENAULT XING
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-7133
Mailing Address - Country:US
Mailing Address - Phone:865-805-9562
Mailing Address - Fax:
Practice Address - Street 1:1546 N GATEWAY AVE
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:TN
Practice Address - Zip Code:37854-4112
Practice Address - Country:US
Practice Address - Phone:865-805-9562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11043122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist