Provider Demographics
NPI:1194896639
Name:BOROLE, SMITA
Entity type:Individual
Prefix:DR
First Name:SMITA
Middle Name:
Last Name:BOROLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 860036
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0036
Mailing Address - Country:US
Mailing Address - Phone:800-487-4867
Mailing Address - Fax:216-593-7433
Practice Address - Street 1:11340 PARKSIDE DR
Practice Address - Street 2:SUITE 2110
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1971
Practice Address - Country:US
Practice Address - Phone:800-487-4867
Practice Address - Fax:216-593-7433
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN77961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice