Healthcare Provider Details

I. General information

NPI: 1619126943
Provider Name (Legal Business Name): NEGAR BOLOORCHI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 09/12/2021
Certification Date: 09/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SAN MIGUEL DR
WALNUT CREEK CA
94596-8606
US

IV. Provider business mailing address

2699 E CALIFORNIA BLVD
SAN MARINO CA
91108-1404
US

V. Phone/Fax

Practice location:
  • Phone: 925-949-8427
  • Fax:
Mailing address:
  • Phone: 626-354-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number28774
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number1535
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number28774
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number57464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: