Pacific Dental Group

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

40351 Issued in CA

Legal business name

PACIFIC DENTAL GROUP

Practice address

1523 5TH Ave
San Rafael, CA 94901-1806

Phone

(415) 453-6277

Fax

(415) 453-6412

NPI assigned

Nov 15, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Clark Fong, DDS

Title

Owner

Phone

(415) 453-6277

Specialties & licenses 1

Addresses

Tax ID family

Dr Clark L Fong DDS a Professional Dental Corporation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Dr. Clark L. Fong, DDS, a Professional Dental Corporation

  • Dentist
  • San Mateo, CA
  • NPI 1578803268
  NPD tax ID

Locations

Practitioners 2

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

• Madeline Fong, DDS

  • Dentist
  • San Rafael, CA
  • NPI 1194555144
  NPD (past)
• 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": "1384473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384473600000",
    "number": "1669802435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1523 5TH AVE",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949011806",
            "telephone_number": "415-453-6277",
            "fax_number": "415-453-6412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1523 5TH AVE",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949011806",
            "telephone_number": "415-453-6277",
            "fax_number": "415-453-6412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-15",
        "last_updated": "2013-11-15",
        "status": "A",
        "authorized_official_last_name": "FONG",
        "authorized_official_first_name": "CLARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "415-453-6277",
        "authorized_official_name_prefix": "Dr.",
        "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": []
}

• Brigitte Ouabo
• Paulette Nicole Ove
• Alexandra Oviatt
• D. Renee Owen, LMFT
• Jagjit Singh Pabla
• Courtney Pack, PPS
• Lisa Pack, LCSW
• Prashant Ashokrao Padmawar, RPH
• Hillary Anne Paffenroth
• Gigi Pagani

• General Practice Dentistry in San Rafael, CA
• Providers in San Rafael, 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 Nov 15, 2013; 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.