Park Avenue Family Dentistry in Pomona - General Practice
Park Avenue Family Dentistry - NPI 1205019858
Park Avenue Family Dentistry is a General Practice in Pomona, California. Park Avenue Family Dentistry practices all healthcare services and medical treatments related to General Practice. The NPI Number for Park Avenue Family Dentistry is 1205019858. The last update date is 2007-12-06.
Park Avenue Family Dentistry's current location address is 1087 N Park Ave, Pomona, California. You can contact this provider via phone number 9096290201. The mailing address for Park Avenue Family Dentistry is 1087 N Park Ave, Pomona, California. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Park Avenue Family Dentistry |
|---|---|
| Address | 1087 N Park Ave, Pomona, California |
| Phone Number | 9096290201 |
| Fax Number | |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | OWNER |
|---|---|
| Authorized Official Name | Judo Soedharsono |
| Credentials | D.D.S. |
| Telephone Number | 9096290201 |
NPI Number Detail
| NPI Number | 1205019858 |
|---|---|
| Provider Enumeration Date | 2007-12-06 |
| Last Updated Date | 2007-12-06 |
Provider Mailing Address Detail
| Address | 1087 N Park Ave |
|---|---|
| City | Pomona |
| State | California (CA) |
| Post Code | 917683026 |
| Phone Number | 9096290201 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | General Practice |
|---|---|
| Taxonomy | 1223G0001X |
| Licence No | 34127 |
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Definition: A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| G9044501 | CA | -- |
Post Comment/ Review Below
What is the unique 10-digit identifier code issued to Park Avenue Family Dentistry by the Centers for Medicare & Medicaid Services?
The Park Avenue Family Dentistry has been assigned the NPI (National Provider Identifier) 1205019858 by the CMS (Centers for Medicare & Medicaid Services). This 10-digit code serves as a unique identification number for healthcare providers.
Could you share the physical location details of Park Avenue Family Dentistry?
The Park Avenue Family Dentistry is situated at 1087 N Park Ave, in the city of Pomona, state of CA, with the zip code 917683026.
What is Park Avenue Family Dentistry's primary area of medical expertise, and what taxonomy classification code corresponds to this specialized field?
The primary area of medical expertise for Park Avenue Family Dentistry is General Practice, and the corresponding taxonomy classification code for this specialized field is 1223G0001X.
On what date did the Park Avenue Family Dentistry receive the assignment of its 1205019858 from the Centers for Medicare & Medicaid Services?
The Park Avenue Family Dentistry was issued its 1205019858 by the Centers for Medicare & Medicaid Services on 2007-12-06.
As of what date was the information regarding Park Avenue Family Dentistry, such as address, specialty, and other details, last verified and confirmed to be up-to-date?
The information related to Park Avenue Family Dentistry, including its address, specialty, and other relevant details, was last verified and confirmed to be up-to-date on 2007-12-06.