Individual
DR. LARRY L BORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3394 MCKELVEY RD, SUITE 104, BRIDGETON, MO 63044-2531
(314) 739-4412
(314) 739-4748
Mailing address
3394 MCKELVEY RD, SUITE 104, BRIDGETON, MO 63044-2531
(314) 739-4412
(314) 739-4748
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
012184
MO
Other
Enumeration date
03/02/2007
Last updated
07/08/2007
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