Provider Demographics
NPI:1932313194
Name:JOANN C BORAAS, DDS, PA
Entity Type:Organization
Organization Name:JOANN C BORAAS, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:BORAAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:612-866-4041
Mailing Address - Street 1:6945 PENN AVE S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2081
Mailing Address - Country:US
Mailing Address - Phone:612-866-4041
Mailing Address - Fax:612-866-4042
Practice Address - Street 1:6945 PENN AVE S
Practice Address - Street 2:SUITE 102
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2081
Practice Address - Country:US
Practice Address - Phone:612-866-4041
Practice Address - Fax:612-866-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN96541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty