# AMERICAN DENTAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497914154
- **Authorized official:** DR. SERGE A PRESCOTT DDS (DENTIST)
- **Authorized official phone:** (626) 337-7271

## Contact information

- **Practice address:** 436 N SUNSET AVE, WEST COVINA, CA 91790-1652
- **Practice address phone:** (626) 337-7271
- **Practice address fax:** (626) 337-8125
- **Mailing address:** 436 N SUNSET AVE, WEST COVINA, CA 91790-1652
- **Mailing address phone:** (626) 337-7271
- **Mailing address fax:** (626) 337-8125

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 35537 | CA | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 14915 | CA | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | 25306 | CA | — |
| 124Q00000X | Dental Hygienist | RDH16115 | CA | — |

## Other

- **Enumeration date:** 06/06/2008
- **Last updated:** 08/18/2009