Active NPI
Laura Borodic, DMD
- Pediatric Dentistry
- Glastonbury, CT
National Provider Identifier
1073199295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 13388
- Practice address
- 379 Naubuc Ave
Glastonbury, CT 06033-1076 - Phone
- (860) 633-5246
- NPI assigned
- Mar 18, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 13388 | CT | Primary |
Addresses
Primary practice location
379 Naubuc Ave
Glastonbury, CT 06033-1076
Mailing address
379 Naubuc Ave
Glastonbury, CT 06033-1076
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210709001189 | CT | Order and Referring Only - Dentist | 1557763802 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13388 | CT | MD | Primary Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688515200000",
"number": "1073199295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "379 NAUBUC AVE",
"city": "GLASTONBURY",
"state": "CT",
"postal_code": "060331076"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "379 NAUBUC AVE",
"city": "GLASTONBURY",
"state": "CT",
"postal_code": "060331076",
"telephone_number": "860-633-5246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORODIC",
"first_name": "LAURA",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-18",
"last_updated": "2023-07-05",
"certification_date": "2023-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CT",
"license": "13388",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glastonbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.