La Verne Modern Dentistry, Prof. Corp.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

LA VERNE MODERN DENTISTRY, PROF. CORP.

Practice address

1500 Foothill Blvd
La Verne, CA 91750-3434

Phone

(909) 906-3765

Fax

(909) 962-8201

NPI assigned

Jul 17, 2026

Organization subpart

No

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

Authorized official

Name

Abanub Wasfy Farag, DMD

Title

Owner

Phone

(909) 906-3765

Specialties & licenses 1

Addresses

Other names 1

• La Verne Modern Dentistry Doing business as

Locations

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

{
    "created_epoch": "1784246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787097600000",
    "number": "1215857404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660041",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752660041",
            "telephone_number": "714-845-8890",
            "fax_number": "303-952-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 FOOTHILL BLVD",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917503434",
            "telephone_number": "909-906-3765",
            "fax_number": "909-962-8201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA VERNE MODERN DENTISTRY, PROF. CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-07-17",
        "last_updated": "2026-08-19",
        "certification_date": "2026-08-19",
        "status": "A",
        "authorized_official_last_name": "FARAG",
        "authorized_official_first_name": "ABANUB",
        "authorized_official_middle_name": "WASFY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-906-3765",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "La Verne Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in La Verne, CA
• Providers in La Verne, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2026; 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.