Provider Demographics
NPI:1548954803
Name:DE SOUZA BORGES, STALIN H (DMD)
Entity type:Individual
Prefix:DR
First Name:STALIN
Middle Name:H
Last Name:DE SOUZA BORGES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 TORRINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31757-3903
Mailing Address - Country:US
Mailing Address - Phone:908-446-9873
Mailing Address - Fax:
Practice Address - Street 1:202 TORRINGTON BLVD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757-3903
Practice Address - Country:US
Practice Address - Phone:908-446-9873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN123062122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist