Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DS036141 | PA |
Y | 1223D0004X | Dentist Anesthesiologist | DS036141 | PA |
NPI | 1780716878 |
---|---|
Provider Name | Dr. Jeffrey James Borandi |
First Address | Wexford, PA 15090 |
Second Address | Zelienople, PA 16063-1406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 22/08/2016 |