Provider Demographics
NPI:1154989770
Name:BOROWICZ, MATTHEW GREGORY (DDS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GREGORY
Last Name:BOROWICZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 33RD AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55427-2107
Mailing Address - Country:US
Mailing Address - Phone:218-478-4527
Mailing Address - Fax:
Practice Address - Street 1:10611 FRANCE AVE S STE 201
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3554
Practice Address - Country:US
Practice Address - Phone:952-881-8404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist