Provider Demographics
NPI:1679557045
Name:BORGELLA, REGINALD (DDS)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:BORGELLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:REGINALD
Other - Middle Name:
Other - Last Name:BORGELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3102 KINGSBRIDGE AVE #1E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:718-543-9786
Mailing Address - Fax:718-543-4075
Practice Address - Street 1:3102 KINGSBRIDGE AVE #1E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:718-543-9786
Practice Address - Fax:718-543-4075
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047243122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist