Provider Demographics
NPI:1528289261
Name:UNG, BORASAMY NICOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:BORASAMY
Middle Name:NICOLE
Last Name:UNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 E COMMERCIAL BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:954-667-6507
Mailing Address - Fax:954-776-9909
Practice Address - Street 1:2480 E COMMERCIAL BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-667-6507
Practice Address - Fax:954-776-9909
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN102141223E0200X
CA387631223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics