Individual provider Active NPI

Adrian Paul Kavanagh, DMD

  • General Practice Dentistry
  • Fontana, CA
National Provider Identifier
1538903299
Registry record updated Nov 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DDS112361 Issued in CA
Practice address
14305 Baseline Ave
Fontana, CA 92336-3631
Phone
(909) 355-1700
NPI assigned
Jun 19, 2024
Last updated
Nov 24, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DDS112361 CA Primary
General Practice Dentistry 1223G0001X D012222 AZ

Addresses

Primary practice location

14305 Baseline Ave
Fontana, CA 92336-3631

Mailing address

7057 Aloe LN
Fontana, CA 92336-2902
Phone (909) 609-4431

Other practice location 1

1629 S Riverside Ave
Rialto, CA 92376-7707
Phone (909) 421-2225

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
D012222AZMDGeneral Practice Dentistry
DDS112361CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Compean and Jefferson Dental Corporation General Practice PastSince Nov 30, 2025 Accepting new patients
Sudhakar R. Chokka, DDS, Inc. General Practice Past Accepting new patients
Horizon Modern Dentistry and Orthodontics, LLP General Practice PastSince Jun 23, 2024 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1718755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763942400000",
    "number": "1538903299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7057 ALOE LN",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923362902",
            "telephone_number": "909-609-4431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14305 BASELINE AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923363631",
            "telephone_number": "909-355-1700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1629 S Riverside Ave",
            "address_purpose": "LOCATION",
            "city": "Rialto",
            "state": "CA",
            "postal_code": "923767707",
            "country_code": "US",
            "telephone_number": "909-421-2225",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAVANAGH",
        "first_name": "ADRIAN",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-19",
        "last_updated": "2025-11-24",
        "certification_date": "2025-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS112361",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D012222",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2025; 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.