Tyler Dale Borg, D.D.S. , M.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

202449 Issued in CO

Practice address

11178 Huron St Ste 100
Northglenn, CO 80234-3115

Phone

(303) 457-9617

NPI assigned

Jun 25, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Colorado Gum Care

  • Periodontics
  • Broomfield, CO
  • NPI 1629414677
  NPD (past)

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

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492646400000",
    "number": "1780948794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11178 HURON ST STE 100",
            "city": "NORTHGLENN",
            "state": "CO",
            "postal_code": "802343115",
            "telephone_number": "303-457-9617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11178 HURON ST STE 100",
            "city": "NORTHGLENN",
            "state": "CO",
            "postal_code": "802343115",
            "telephone_number": "303-457-9617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORG",
        "first_name": "TYLER",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "D.D.S. , M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-25",
        "last_updated": "2017-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CO",
            "license": "202449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Blum, RN
• Michael D Boerner, D.C.
• Hillary Bohlander
• Jayda Bolan
• Krista Borden
• Christina Boss
• Taryn Bostwick, MA
• Boulder Valley Gastroenterology Inc.
• Mary Boyajian, MA, BCBA
• Hank Brand

• Periodontics in Northglenn, CO
• Providers in Northglenn, CO by specialty
• Periodontics in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2017; 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.

Verify at the official NPI Registry.