Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2007 | PR |
Y | 1223P0221X | Pediatric Dentist | DD3017 | NM |
NPI | 1043401268 |
---|---|
Provider Name | Daniel A Borrero |
First Address | Santa Fe, NM 87507-3001 |
Second Address | Santa Fe, NM 87507-3001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 16/12/2011 |