Provider Demographics
NPI:1881815728
Name:FARDAD BORHANI DMD INC
Entity Type:Organization
Organization Name:FARDAD BORHANI DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BORHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:909-792-8079
Mailing Address - Street 1:1690 BARTON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7761
Mailing Address - Country:US
Mailing Address - Phone:909-557-4652
Mailing Address - Fax:
Practice Address - Street 1:1690 BARTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-7761
Practice Address - Country:US
Practice Address - Phone:909-557-4652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty