Individual
DR. BLAKE BORELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
6288 RONALD REAGAN DR., LAKE SAINT LOUIS, MO 63367
(636) 625-4224
(314) 845-1864
Mailing address
1203 SAINT CHARLES ST, APT. 5A, SAINT LOUIS, MO 63103-1963
(636) 625-4224
(314) 845-1864
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2008019644
MO
Other
Enumeration date
09/16/2010
Last updated
02/02/2011
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