Provider Demographics
NPI:1710178405
Name:BORNA, FARSHID (DDSMS)
Entity Type:Individual
Prefix:DR
First Name:FARSHID
Middle Name:
Last Name:BORNA
Suffix:
Gender:M
Credentials:DDSMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 CENTURY PARK E STE 405
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2007
Mailing Address - Country:US
Mailing Address - Phone:310-553-1583
Mailing Address - Fax:310-553-6718
Practice Address - Street 1:2080 CENTURY PARK E STE 405
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2007
Practice Address - Country:US
Practice Address - Phone:310-553-1583
Practice Address - Fax:310-553-6718
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA460281223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics