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Organization
PACIFIC DENTAL GROUP
Active
Organization
PACIFIC DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLARK FONG DDS (OWNER)
(415) 453-6277
Entity
Organization
Contact information
Practice address
1523 5TH AVE, SAN RAFAEL, CA 94901-1806
(415) 453-6277
(415) 453-6412
Mailing address
1523 5TH AVE, SAN RAFAEL, CA 94901-1806
(415) 453-6277
(415) 453-6412
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
40351
CA
Other
Enumeration date
11/15/2013
Last updated
11/15/2013
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