Provider Demographics
NPI:1306980453
Name:BORST, MITCHELL C SR (DMD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:C
Last Name:BORST
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-7031
Mailing Address - Country:US
Mailing Address - Phone:727-733-4113
Mailing Address - Fax:
Practice Address - Street 1:822 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-7031
Practice Address - Country:US
Practice Address - Phone:727-733-4113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00134811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice