Richard H. Mogensen DDS Apc

Primary specialty

DentistTaxonomy code 122300000X

License

CA 21733 Issued in CA

Legal business name

RICHARD H. MOGENSEN DDS APC

Doing business as

Fruitvale Dental Group

Practice address

1624 Franklin St
Suite 1206
Oakland, CA 94612-2824

Phone

(510) 452-5555

NPI assigned

May 10, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Richard H. Mogensen, DDS

Title

President

Phone

(510) 452-5555

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fruitvale Dental Group Doing business as

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1750595567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1624 FRANKLIN ST",
            "address_2": "SUITE 1206",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946122824",
            "telephone_number": "510-452-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1624 FRANKLIN ST",
            "address_2": "SUITE 1206",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946122824",
            "telephone_number": "510-452-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD H. MOGENSEN DDS APC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOGENSEN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "510-452-5555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "CA 21733",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G92157-01",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fruitvale Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sherlene L Rice
• Edward J. Rich, MD
• Richard a Kahn MD Inc
• Richard a Nusser MD Inc
• Richard H Lee Jr MD Inc
• Richard L Wacht MD Medical Corp
• Nicole Celeste Richard, SUDRC
• Jacquelyn Richards
• Lawrence Thomas Richards, MD
• Rebecca Richards, M.S.

• Dentist in Oakland, CA
• Providers in Oakland, CA by specialty
• Dentist in California

• 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.