Healthcare Provider Details

I. General information

NPI: 1306817770
Provider Name (Legal Business Name): BORAN DENTAL ASSOC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S FOURTH ST
MINERSVILLE PA
17954
US

IV. Provider business mailing address

240 S FOURTH ST
MINERSVILLE PA
17954
US

V. Phone/Fax

Practice location:
  • Phone: 570-544-4845
  • Fax: 570-544-8036
Mailing address:
  • Phone: 570-544-4845
  • Fax: 570-544-8036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. BARRY JOSEPH BORAN SR.
Title or Position: PRESIDENT
Credential: DMD
Phone: 570-544-4845