| Doctor Name: | DR. BLAKE BORELLO |
| NPI Number: | 1902114515 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.D.S., M.S. |
| License Number: | 2008019644 |
| Business Practice Address: | 6288 Ronald Reagan Dr. Lake Saint Louis, MO - 63367 |
| Business Phone Number: | 6366254224 |
| Business Fax Number: | 3148451864 |
| Mailing Address: | 1203 Saint Charles St, Apt. 5a SAINT LOUIS |
| State: | MO |
| Postal Code: | 631031963 |
| Phone Number: | 6366254224 |
| Fax Number: | 3148451864 |
| NPI Enumeration Date: | 09/16/2010 |
| NPI Last Update Date: | 02/02/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223X0400X |
| License Number: | 2008019644 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Orthodontics and Dentofacial Orthopedics |
| Taxonomy Definition: | 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 functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |