Provider Demographics
NPI:1932303963
Name:WILLIAM POMEROY DDS APC
Entity Type:Organization
Organization Name:WILLIAM POMEROY DDS APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:IGNATIUS
Authorized Official - Last Name:POMEROY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-378-2712
Mailing Address - Street 1:27762 ANTONIO PKWY
Mailing Address - Street 2:#L1-619
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694
Mailing Address - Country:US
Mailing Address - Phone:949-378-2712
Mailing Address - Fax:
Practice Address - Street 1:600 S GRAND AVE
Practice Address - Street 2:STE #102
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4152
Practice Address - Country:US
Practice Address - Phone:714-836-5611
Practice Address - Fax:714-836-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39196122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA519157OtherDENTICAL PROVIDER NUMBER