Provider Demographics
NPI:1316025968
Name:BORAN, ELLEN F (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:F
Last Name:BORAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 E. MAIN ST.
Mailing Address - Street 2:P.O. BOX 369
Mailing Address - City:HEGINS
Mailing Address - State:PA
Mailing Address - Zip Code:17938-0000
Mailing Address - Country:US
Mailing Address - Phone:570-682-8143
Mailing Address - Fax:570-682-8630
Practice Address - Street 1:1144 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:HEGINS
Practice Address - State:PA
Practice Address - Zip Code:17938-0000
Practice Address - Country:US
Practice Address - Phone:570-682-8143
Practice Address - Fax:570-682-8630
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021657L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice