Provider Demographics
NPI:1568524908
Name:BORNSTEIN, DANIEL A (DMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:BORNSTEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 MONTGOMERY DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4500
Mailing Address - Country:US
Mailing Address - Phone:707-546-4989
Mailing Address - Fax:707-546-2103
Practice Address - Street 1:1515 MONTGOMERY DR
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4500
Practice Address - Country:US
Practice Address - Phone:707-546-4989
Practice Address - Fax:707-546-2103
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA312091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice