| Pacific Dental Group | |
|
1523 5th Ave San Rafael CA 94901-1806 | |
| (415) 453-6277 | |
| (415) 453-6412 |
| Full Name | Pacific Dental Group |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1523 5th Ave, San Rafael, California |
| Authorized Official Name and Position | Clark Fong (OWNER) |
| Authorized Official Contact | 4154536277 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pacific Dental Group 1523 5th Ave San Rafael CA 94901-1806 Ph: (415) 453-6277 | Pacific Dental Group 1523 5th Ave San Rafael CA 94901-1806 Ph: (415) 453-6277 |
| NPI Number | 1669802435 |
|---|---|
| Provider Enumeration Date | 11/15/2013 |
| Last Update Date | 11/15/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669802435 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 40351 (California) | Primary |
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