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General NPI Number Information
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NPI Number | 1881815728
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Entity Type | Organization
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Legal Business Name | FARDAD BORHANI DMD INC
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 08/25/2008
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Provider Practice Location Address
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Address Line | 1690 BARTON RD SUITE 100
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City | REDLANDS
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State | CA
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Zip | 92373-7761
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Country | US
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Telephone | 909-557-4652
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Fax |
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Provider Business Mailing Address
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Address Line | 1690 BARTON RD SUITE 100
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City | REDLANDS
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State | CA
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Zip | 92373-7761
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Country | US
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Telephone | 909-557-4652
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | FARDAD BORHANI
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Credential | DMD
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Telephone | 909-792-8079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 54068
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License Number State | CA
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