Provider Demographics
NPI:1174714471
Name:BORGMAN, ALYSIA CHRISTINA (DDS)
Entity type:Individual
Prefix:DR
First Name:ALYSIA
Middle Name:CHRISTINA
Last Name:BORGMAN
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 1:1617 WESTCLIFF DR
Mailing Address - Street 2:203
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-646-7789
Mailing Address - Fax:949-631-2069
Practice Address - Street 1:1617 WESTCLIFF DR
Practice Address - Street 2:203
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-646-7789
Practice Address - Fax:949-631-2069
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42636122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist