Provider Demographics
NPI:1346756103
Name:BORENGASSER FAMILY DENTAL, PLLC
Entity Type:Organization
Organization Name:BORENGASSER FAMILY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:BORENGASSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-242-3340
Mailing Address - Street 1:9205 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-7060
Mailing Address - Country:US
Mailing Address - Phone:479-719-1373
Mailing Address - Fax:
Practice Address - Street 1:3510 S 79TH ST STE 100
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6250
Practice Address - Country:US
Practice Address - Phone:479-242-3340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3525261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental