Provider Demographics
NPI:1962556506
Name:BORNA, IRAJ (DDS INC)
Entity type:Individual
Prefix:
First Name:IRAJ
Middle Name:
Last Name:BORNA
Suffix:
Gender:M
Credentials:DDS INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 RESEDA BL
Mailing Address - Street 2:#5
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4249
Mailing Address - Country:US
Mailing Address - Phone:818-708-7311
Mailing Address - Fax:818-708-3930
Practice Address - Street 1:6915 RESEDA BL
Practice Address - Street 2:#5
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4249
Practice Address - Country:US
Practice Address - Phone:818-708-7311
Practice Address - Fax:818-708-3930
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB3689001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist