Individual
JAIMIE CAROLINA BORGENICHT-LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D
Contact information
Practice address
131 NW 100TH AVE, PLANTATION, FL 33324-7034
(954) 476-4537
(954) 476-7734
Mailing address
131 NW 100TH AVE, PLANTATION, FL 33324
(321) 945-6253
(954) 476-7734
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
1672
FL
122300000X
Dentist
Primary
DN24070
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1672
FLORIDA STATE BOARD OF DENTISTRY
FL
Enumeration date
05/11/2017
Last updated
10/08/2024
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