Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 018.001765 | IL |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 08807 | IA |
NPI | 1013234194 |
---|---|
Provider Name | Dr. Ryan Norman Borgwardt |
First Address | Waterloo, IA 50702-5705 |
Second Address | Waterloo, IA 50701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2010 |
Last Update Date | 11/09/2018 |