Individual provider · Type 1 NPI
Blake Borello, DDS, M.S.
Orthodontics and Dentofacial Orthopedics Dentistry · Lake St. Louis, MO
Practice location
6288 Ronald Reagan Dr.
Lake St. Louis, MO 63367
Fax (314) 845-1864
Mailing address
1203 Saint Charles St, Apt. 5A
St. Louis, MO 63103-1963
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry Primary | 1223X0400X | 2008019644 (MO) |
Orthodontics and Dentofacial Orthopedics Dentistry: That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of funct…
Another provider at this address
Other orthodontics and dentofacial orthopedics dentistry providers in Lake St. Louis
About NPI 1902114515
Blake Borello, DDS, M.S.'s National Provider Identifier is 1902114515, issued on Sep 16, 2010. The primary taxonomy on file is Orthodontics and Dentofacial Orthopedics Dentistry (1223X0400X), and the practice location is in Lake St. Louis, MO. The record was last updated on Feb 2, 2011.