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Organization

BORELLO ORTHODONTICS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BLAKE BORELLO D.D.S., M.S. (OWNER)
(636) 625-4224
Entity
Organization

Contact information

Practice address
6288 RONALD REAGAN DR., LAKE SAINT LOUIS, MO 63367
(636) 625-4224
Mailing address
1203 SAINT CHARLES ST, APT. 5A, SAINT LOUIS, MO 63103-1963
(636) 625-4224

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
2008019644
MO

Other

Enumeration date
09/23/2010
Last updated
02/02/2011
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