Provider Demographics
NPI:1396936993
Name:FARSHID BORNA DDS INC
Entity type:Organization
Organization Name:FARSHID BORNA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARSHID
Authorized Official - Middle Name:
Authorized Official - Last Name:BORNA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:310-553-1583
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46028261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental