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General NPI Number Information
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NPI Number | 1669074746
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Entity Type | Organization
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Legal Business Name | BORIS LA NOIRE DDS INC
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Dates
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Enumeration Date | 11/12/2020
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 100 LONGBROOK WAY STE 16
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City | PLEASANT HILL
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State | CA
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Zip | 94523-2429
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Country | US
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Telephone | 925-332-5299
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Fax | 925-332-5296
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Provider Business Mailing Address
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Address Line | 4870 GENEVA AVE
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City | CONCORD
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State | CA
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Zip | 94521-2227
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Country | US
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Telephone | 925-708-7030
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Fax |
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. BORIS M LA NOIRE
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Credential | DDS
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Telephone | 925-708-7703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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