Provider Demographics
NPI:1275090854
Name:AUDREY BOROS DDS INC
Entity Type:Organization
Organization Name:AUDREY BOROS DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOROS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-264-5557
Mailing Address - Street 1:1244 7TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1648
Mailing Address - Country:US
Mailing Address - Phone:310-264-5557
Mailing Address - Fax:310-235-1077
Practice Address - Street 1:1244 7TH ST STE 102
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1648
Practice Address - Country:US
Practice Address - Phone:310-264-5557
Practice Address - Fax:310-235-1077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental