NPIMap

Organization Active NPI

Pakravan Dental Corporation

Doing business as West Coast Dental Group of Orange

  • General Practice Dentistry
  • Orange, CA
National Provider Identifier
1073737524
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
39862 Issued in CA
Legal business name
PAKRAVAN DENTAL CORPORATION
Doing business as
West Coast Dental Group of Orange
Practice address
179 N Tustin St
Orange, CA 92867-7716
Phone
(714) 288-1035
Fax
(714) 288-2784
NPI assigned
Apr 13, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Farid Pakravan
Title
Owner
Phone
(714) 288-1035

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 39862 CA Primary

Addresses

Primary practice location

179 N Tustin St
Orange, CA 92867-7716

Mailing address

179 N Tustin St
Orange, CA 92867-7716
Phone (714) 288-1035

Other names 1

  • WEST COAST DENTAL GROUP OF ORANGE Doing business as

National Provider Directory

National Provider Directory

Locations

179 N Tustin St
Orange, CA 92867
Phone (714) 288-1035

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073737524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "179 N TUSTIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928677716",
            "telephone_number": "714-288-1035",
            "fax_number": "714-288-2784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "179 N TUSTIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928677716",
            "telephone_number": "714-288-1035",
            "fax_number": "714-288-2784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAKRAVAN DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-13",
        "last_updated": "2020-08-22",
        "certification_date": "2020-07-30",
        "status": "A",
        "authorized_official_last_name": "PAKRAVAN",
        "authorized_official_first_name": "FARID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-288-1035"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "39862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WEST COAST DENTAL GROUP OF ORANGE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orange, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.