Provider Demographics
NPI:1669074746
Name:BORIS LA NOIRE DDS INC
Entity type:Organization
Organization Name:BORIS LA NOIRE DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:LA NOIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-708-7703
Mailing Address - Street 1:4870 GENEVA AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-2227
Mailing Address - Country:US
Mailing Address - Phone:925-708-7030
Mailing Address - Fax:
Practice Address - Street 1:100 LONGBROOK WAY STE 16
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2429
Practice Address - Country:US
Practice Address - Phone:925-332-5299
Practice Address - Fax:925-332-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental