Provider Demographics
NPI:1124139647
Name:GHASSEMZADEH BORGUET, MILITA (DMD)
Entity type:Individual
Prefix:DR
First Name:MILITA
Middle Name:
Last Name:GHASSEMZADEH BORGUET
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:MILITA
Other - Middle Name:G
Other - Last Name:BORGUET
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:110 N ESSEX AVE
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2206
Mailing Address - Country:US
Mailing Address - Phone:610-664-9510
Mailing Address - Fax:610-664-8468
Practice Address - Street 1:110 N ESSEX AVE
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2206
Practice Address - Country:US
Practice Address - Phone:610-664-9510
Practice Address - Fax:610-664-8468
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ181051223P0300X
PADS027843L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA776058OtherBLUE CROSS BLUE SHEILD