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PARK AVENUE FAMILY DENTISTRY
NPI 1205019858
Dentist - General Practice in Pomona, CA

Active since December 06, 2007
1087 N PARK AVE, POMONA, CA 91768(909) 629-0201 Get Directions Write a Review

NPPES record last updated: December 6, 2007. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Park Avenue Family Dentistry NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PARK AVENUE FAMILY DENTISTRY (NPI 1205019858) is a healthcare organization registered as a general practice in Pomona, California and active in the NPI registry since December 2007. The organization lists Soedharsono Judo, Owner, as its authorized official.

NPPES Registry Identity

NPI1205019858
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NamePARK AVENUE FAMILY DENTISTRY
Location Address1087 N PARK AVEPomona, CA 91768-3026
Mailing Address1087 N Park AvePomona, CA 91768-3026 · (909) 629-0201
Phone(909) 629-0201
Organization SubpartNo
Authorized OfficialSoedharsono JudoOwner · (909) 629-0201
Enumeration DateDecember 6, 2007
✔ NPI 1205019858 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in CA · 34127
Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

1087 N PARK AVE, Pomona, CA 91768
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Other Names 1

Doing Business AsPark Avenue Family Dentistry

Other Identifiers 1

MedicaidG9044501CA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Park Avenue Family Dentistry's NPI number?

The NPI number for Park Avenue Family Dentistry is 1205019858. It was assigned to this organization in the NPPES registry on December 6, 2007.

Where is Park Avenue Family Dentistry located?

Park Avenue Family Dentistry is located at 1087 N Park Ave, Pomona, CA 91768. The listed phone number is (909) 629-0201.

What is Park Avenue Family Dentistry's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Park Avenue Family Dentistry was last updated on December 6, 2007. NPI Profile syncs with the weekly NPPES data releases published by CMS.