Provider Demographics
NPI:1619126943
Name:BOLOORCHI, NEGAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEGAR
Middle Name:
Last Name:BOLOORCHI
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 1:2699 E CALIFORNIA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1404
Mailing Address - Country:US
Mailing Address - Phone:626-354-1440
Mailing Address - Fax:
Practice Address - Street 1:1800 SAN MIGUEL DR
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-8606
Practice Address - Country:US
Practice Address - Phone:925-949-8427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28774122300000X, 1223G0001X
CA15351223D0004X
CA57464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0004XDental ProvidersDentistDentist Anesthesiologist
No1223G0001XDental ProvidersDentistGeneral Practice