Individual provider Active NPI

Yolanda Ibarreta Borbon, DDS

  • General Practice Dentistry
  • New London, CT
National Provider Identifier
1750460465
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
008988 Issued in CT
Practice address
217 Broad St
New London, CT 06320-5314
Phone
(860) 437-8493
Fax
(860) 437-8521
NPI assigned
Nov 3, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 008988 CT Primary

Addresses

Primary practice location

217 Broad St
New London, CT 06320-5314

Mailing address

217 Broad St
New London, CT 06320-5314
Phone (860) 437-8493

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180523000708 CT Order and Referring Only - DentistPractitioner - Dentist 7315202363

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
008988CTMDFamily Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750460465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 BROAD ST",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063205314",
            "telephone_number": "860-437-8493",
            "fax_number": "860-437-8521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 BROAD ST",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063205314",
            "telephone_number": "860-437-8493",
            "fax_number": "860-437-8521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORBON",
        "first_name": "YOLANDA",
        "middle_name": "IBARRETA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "008988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New London, CT

Sources for this page

Verify at the official NPI Registry.