Provider Demographics
NPI:1003639048
Name:CHARLES E BOREN DDS PC
Entity type:Organization
Organization Name:CHARLES E BOREN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:713-655-7673
Mailing Address - Street 1:5200 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3915
Mailing Address - Country:US
Mailing Address - Phone:713-655-7673
Mailing Address - Fax:713-655-7645
Practice Address - Street 1:5200 CEDAR ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3915
Practice Address - Country:US
Practice Address - Phone:713-655-7673
Practice Address - Fax:713-655-7645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty