PACIFIC DENTAL GROUP (NPI# 1669802435) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669802435 |
| Entity Type | Organization |
| Organization Name | PACIFIC DENTAL GROUP |
| Practice Address |
1523 5th Ave San Rafael CA 94901-1806 |
| Practice Telephone | 4154536277 |
| Practice Fax Number | 4154536412 |
| Mailing Telephone | 4154536277 |
| Mailing Fax Number | 4154536412 |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2013-11-15 |
| Authorized Official Name | DR. CLARK FONG (OWNER) |
| Authorized Official Telephone | 4154536277 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
40351 | CA | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740405612 | Pacific Dental Group | Dentist | 310 Third Ave, Ste C 1b, Chula Vista, CA 91910 | 2007-04-16 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | PACIFIC DENTAL GROUP, L.L.C. | 5707 N Interstate Ave, Portland, OR 97217 |
| Street Address |
1523 5TH AVE |
| City | SAN RAFAEL |
| State | CA |
| Zip Code | 94901-1806 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780207134 | Marianne Haissman Stefancic | Marriage & Family Therapist | 409 Forbes Ave., San Rafael, CA 94901 | 2020-05-20 |
| 1093292765 | Marin Community Clinic | Clinic/Center | 411 4th Strteet, Suite A, San Rafael, CA 94901 | 2018-07-25 |
| 1275052516 | Laura Ellen Silverstein | Marriage & Family Therapist | 600 Fifth Avenue, San Rafael, CA 94901 | 2017-09-19 |
| 1689101107 | Marin Family Recovery | Clinic/Center | 1209 Third St. Ste 4, San Rafael, CA 94901 | 2017-05-15 |
| 1376070011 | Tencia Beavers-sanchez | Counselor | 710 C Street Suite#8, Marin Outpatient&recoveryservices, Sanrafael, CA 94901 | 2017-05-12 |
| 1326584905 | Jamie Waterman | Emergency Medical Technician, Basic | 675 Sir Francis Drake Blvd, Kentfield, CA 94901 | 2017-01-06 |
| 1295270676 | Stephen Marks | Counselor | 900 Fifth Avenue, Suite 150, ; San Rafael, CA 94901 | 2016-12-21 |
| 1497299812 | Vesna Sturman | Psychologist | 712 D St Ste L, San Rafael, CA 94901 | 2016-12-05 |
| 1063955771 | Carol Dutton Hollenberg | Behavior Technician | 503 D St., San Rafael, CA 94901 | 2016-11-29 |
| 1083069447 | Bay Area Community Resources | Community/Behavioral Health | 103 Shoreline Parkway, San Rafael, CA 94901 | 2016-05-04 |
| Find all providers in zip 94901 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| 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. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043791890 | A Mola Dds Apc | Dentist | 1050 Northgate Dr Ste 505, San Rafael, CA 94903-2542 | 2018-08-28 |
| 1598272890 | Emma Abramyan | Dentist | 361 3rd St Ste H, San Rafael, CA 94901-3580 | 2018-01-08 |
| 1598169534 | Peter Fong | Dentist | 2 Civic Center Dr., #4429, San Rafael, CA 94913-4429 | 2014-10-20 |
| 1154669190 | Chase Kotula Dental Partnership | Dentist | 4050 Redwood Hwy, Suite A, San Rafael, CA 94903-5149 | 2013-01-25 |
| 1740504059 | Peter Zahedi I | Dentist | 905 Lincoln Ave, San Rafael, CA 94901-3331 | 2010-03-16 |
| 1336378710 | Emad S. Elgendy | Dentist | 211 G St Apt 7, San Rafael, CA 94901-1834 | 2009-07-07 |
| 1184881195 | Kirby Man Yin Yee | Dentist | 912 Grand Ave Ste 101, San Rafael, CA 94901-3552 | 2008-05-19 |
| 1578777918 | Peter Fong, Dds, Inc. | Dentist | 1050 Northgate Dr Ste 139, San Rafael, CA 94903-2559 | 2007-05-09 |
| 1295955409 | Theodore Carle Schwarftz | Dentist | 630 Freitas Parkway, San Rafael, CA 94903 | 2007-04-27 |
| 1639398092 | Steven S Chase | Dentist | 4050 Redwood Hwy Ste A, San Rafael, CA 94903-5149 | 2007-04-24 |
| Find all providers in SAN RAFAEL | ||||
| City | SAN RAFAEL |
| Zip Code | 94901 |
Please comment or provide details below to improve the information on PACIFIC DENTAL GROUP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.