NPI 1447156245 · live from the CMS NPI Registry
109 Dental Group, Professional Corporation
Dentist, General Practice in Fountain Valley, CA. National Provider Identifier 1447156245, active.
NPI record
| NPI | 1447156245 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist, General Practice 1223G0001X |
| Practice location | 10900 Warner Ave Ste 109, Fountain Valley, CA 92708 |
| Practice phone | 714-963-5634 |
| Mailing address | 400 Mobil Ave Ste A4, Camarillo, CA 93010 |
| Enumerated | October 17, 2026 |
| Last updated | October 17, 2026 |
| Authorized official | Thomas Pham, Owner Dentist |
| Other names | 109 Dental Group |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, General Practice primary | 1223G0001X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.