Provider Demographics
NPI:1306817770
Name:BORAN DENTAL ASSOC PC
Entity Type:Organization
Organization Name:BORAN DENTAL ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BORAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-544-4845
Mailing Address - Street 1:240 S FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:MINERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17954
Mailing Address - Country:US
Mailing Address - Phone:570-544-4845
Mailing Address - Fax:570-544-8036
Practice Address - Street 1:240 S FOURTH ST
Practice Address - Street 2:
Practice Address - City:MINERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17954
Practice Address - Country:US
Practice Address - Phone:570-544-4845
Practice Address - Fax:570-544-8036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA725533OtherUNITED CONCORDIA