| Park Avenue Family Dentistry | |
|
1087 N Park Ave Pomona CA 91768-3026 | |
| (909) 629-0201 | |
| Not Available |
| Full Name | Park Avenue Family Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1087 N Park Ave, Pomona, California |
| Authorized Official Name and Position | Soedharsono Judo (OWNER) |
| Authorized Official Contact | 9096290201 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Park Avenue Family Dentistry 1087 N Park Ave Pomona CA 91768-3026 Ph: (909) 629-0201 | Park Avenue Family Dentistry 1087 N Park Ave Pomona CA 91768-3026 Ph: (909) 629-0201 |
| NPI Number | 1205019858 |
|---|---|
| Provider Enumeration Date | 12/06/2007 |
| Last Update Date | 12/06/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205019858 | NPI | - | NPPES |
| G9044501 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 34127 (California) | Primary |
Larissa Gushansky, Dds Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 887 E 2nd St, Suite B, Pomona, CA 91766 Phone: 909-865-8595 | |
Pravinchandra Makadia Dds Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 826 E Mission Blvd, Pomona, CA 91766 Phone: 909-622-1817 Fax: 909-622-8750 | |
Miro Itskovich, Dds Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 847 Philadelphia St., Pomona, CA 91766 Phone: 909-927-4177 | |
Dr. Mehta's Grove Dental Office Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3167 N. Garey Ave, Pomona, CA 91767 Phone: 909-596-7700 Fax: 909-392-4697 | |
Jeffrey B. Thomas, D.d.s. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 160 E Artesia St, Suite 125, Pomona, CA 91767 Phone: 909-622-1261 | |
Larissa Gushansky, Dds Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 887 E 2nd St Ste D, Pomona, CA 91766 Phone: 909-865-8595 | |
Pravinchandra Makadia Dental Corporation Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 826 E Mission Blvd, Pomona, CA 91766 Phone: 909-996-6924 Fax: 909-622-8750 |