Provider Demographics
NPI:1447868864
Name:DOUGLAS P. BORST DDS P.C.
Entity type:Organization
Organization Name:DOUGLAS P. BORST DDS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BORST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-834-0102
Mailing Address - Street 1:1895 GEORGETOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-7137
Mailing Address - Country:US
Mailing Address - Phone:616-457-1610
Mailing Address - Fax:
Practice Address - Street 1:1895 GEORGETOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-7137
Practice Address - Country:US
Practice Address - Phone:616-457-1610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental