Provider Demographics
NPI:1578603551
Name:MCGOVERN AND BORIN DENTAL
Entity Type:Organization
Organization Name:MCGOVERN AND BORIN DENTAL
Other - Org Name:RON BORIN DDS INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:M
Authorized Official - Last Name:BORIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-873-3208
Mailing Address - Street 1:312 W LINE ST
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-3413
Mailing Address - Country:US
Mailing Address - Phone:760-873-3208
Mailing Address - Fax:760-873-7282
Practice Address - Street 1:312 W LINE ST
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3413
Practice Address - Country:US
Practice Address - Phone:760-873-3208
Practice Address - Fax:760-873-7282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA325351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty