Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 08578 | IA |
NPI | 1013166289 |
---|---|
Provider Name | Dr. Derek Steven Borgwardt |
First Address | Iowa City, IA 52246-2213 |
Second Address | Iowa City, IA 52242-1001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2008 |
Last Update Date | 12/09/2008 |