Provider Demographics
NPI:1457370371
Name:BORASKI, MICHAEL C (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:BORASKI
Suffix:
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 1:4111 A OLD BETHLEHEM PK
Mailing Address - Street 2:
Mailing Address - City:TELFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18969-1128
Mailing Address - Country:US
Mailing Address - Phone:215-723-8393
Mailing Address - Fax:215-723-5838
Practice Address - Street 1:4111 A OLD BETHLEHEM PK
Practice Address - Street 2:
Practice Address - City:TELFORD
Practice Address - State:PA
Practice Address - Zip Code:18969-1128
Practice Address - Country:US
Practice Address - Phone:215-723-8393
Practice Address - Fax:215-723-5838
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO19517L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice