OrganizationActive
Park Avenue Family Dentistry
NPI 1205019858 · General Practice Dentistry · Pomona, CA
Park Avenue Family Dentistry is a General Practice Dentistry organization in Pomona, CA (NPI 1205019858).
Provider details
- NPI number
- 1205019858
- Entity type
- Organization
- Primary specialty
- General Practice DentistryDental Providers
- Organization subpart
- No
- Authorized official
- Soedharsono Judo, Owner(909) 629-0201
- License
- 34127 (CA)
Specialties & taxonomies
Dental Providers
Profile Score
Detailed profile(88/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1087 N Park Ave
Pomona, CA 91768-3026
Phone: (909) 629-0201
Street-level locationGet directions
Mailing address
1087 N Park Ave
Pomona, CA 91768-3026
Other names (DBA / former)
- Doing business as
- Park Avenue Family Dentistry
Registry dates
- Enumerated
- 2007-12-06
- Last updated
- 2007-12-06
Frequently asked questions
- What is Park Avenue Family Dentistry's NPI number?
- Park Avenue Family Dentistry's National Provider Identifier (NPI) is 1205019858, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Park Avenue Family Dentistry?
- Park Avenue Family Dentistry is classified in the NPPES registry as General Practice Dentistry (Dental Providers).
- Where is Park Avenue Family Dentistry located?
- Park Avenue Family Dentistry's practice location on file with NPPES is 1087 N Park Ave, Pomona, CA 91768-3026.
- What is Park Avenue Family Dentistry's phone number?
- The practice phone number listed in the NPPES registry for Park Avenue Family Dentistry is (909) 629-0201.
- Who is the authorized official for Park Avenue Family Dentistry?
- The authorized official listed on Park Avenue Family Dentistry's NPPES record is Soedharsono Judo, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Park Avenue Family Dentistry's NPI active?
- Yes — Park Avenue Family Dentistry's NPI (1205019858) is active in the NPPES registry as of the last update on 2007-12-06.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.