Provider Demographics
NPI:1447547369
Name:BORDOW, ALISSA (DDS)
Entity type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:
Last Name:BORDOW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 UNION ST
Mailing Address - Street 2:APT 11
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-3936
Mailing Address - Country:US
Mailing Address - Phone:707-477-6738
Mailing Address - Fax:
Practice Address - Street 1:187 PINE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-5527
Practice Address - Country:US
Practice Address - Phone:415-397-4433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA618051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program