Birch Dental Group

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

40351 Issued in CA

Legal business name

BIRCH DENTAL GROUP

Practice address

155 Birch St
Suite 5
Redwood City, CA 94062-1340

Phone

(650) 366-0552

Fax

(650) 366-0701

NPI assigned

Sep 14, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Clark L Fong, DDS, DDS

Title

Owner

Phone

(650) 366-0552

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michelle M Fong

  • General Practice Dentistry
  • Redwood City, CA
  • NPI 1376114702
  NPD (past)

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

{
    "created_epoch": "1189728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268870400000",
    "number": "1508052382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 BIRCH ST",
            "address_2": "SUITE 5",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940621340",
            "telephone_number": "650-366-0552",
            "fax_number": "650-366-0701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 BIRCH ST",
            "address_2": "SUITE 5",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940621340",
            "telephone_number": "650-366-0552",
            "fax_number": "650-366-0701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIRCH DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-14",
        "last_updated": "2010-03-18",
        "status": "A",
        "authorized_official_last_name": "FONG, DDS",
        "authorized_official_first_name": "CLARK",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "650-366-0552",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "40351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aaron Joseph Bikulcius, LVN
• Kylie Anne Billingsley, PH.D.
• Dominique Laurent Biner, D.C.
• Biotricity Inc.
• Birch Clinic Corporation
• Archita Birla
• Jordana Lynn Blachman, M.D.
• Daniel Blackburn
• Michelle Nakano Blade
• Omar Blake

• General Practice Dentistry in Redwood City, CA
• Providers in Redwood City, 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 Mar 18, 2010; 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.