Monterey County Employee Dental Plan Provider Directory 2019

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Monterey CountyEmployee Dental PlanProvider Directory2019Administered By:Pacific Health Alliance1525 Rollins Road, Suite BBurlingame, CA 940101-800-533-4742

County of Monterey Dental Benefits Summary Calendar Year Max: 2,000.00 per family memberNo Waiting Periods Calendar Year Deductible: 50.00 per member / 100.00 per familyPreventive Covered at 100%Exams2 per calendar yearProphylactic cleanings2 cleanings per calendar yearBitewings2 sets per calendar yearFMX or Panoramic X-Ray1 in 36 monthsFluoride1 per year, benefit only for 18 years of age and underSealants (On non-carious permanent molars)1 per year, benefit only for 15 years of age and underSpace Maintainers for missing primary teeth1 per year, benefit only for 16 years of age and under,Please indicate the space being maintainedBasic Covered at 80%FillingsComposites or amalgams, posterior composites notreduced to amalgamsOral SurgeryIncludes local anesthesia (also general IV)PeriodonticsD4341 one time per quadrant every 12 months, pocketmarkings must be sentEndodonticsRoot CanalsOcclusal GuardFor Bruxism only, excludes TMJ, must submit documentationand requires prior authorizationMajor Covered at 50%CrownsReplacements once every 5 years, prior extractions notBridgescoveredDenturesPostsBuild-upsIn-lays and OnlaysOrthodontia 1500 Life Time Maximum 1500 Lifetime Max(Payable at 50% up to maximum allowable) 1,500.00 per member, no deductible, no age limit, predetermination is needed***Services must be started while on the plan. Servicesstarted prior to joining the plan will NOT be covered.

Services NOT Covered ImplantsAthletic mouth guardsBleachingCosmetic DentistryExperimental ProceduresFractures or Dislocation of JawOrthodontic Services not prescribed andinstalled by a licensed Dentist. Replacement of missing teeth (prior extractions)Alteration or extraction and replacement of sound teethServices related to an occupational injury or sicknessServices rendered in a hospital settingServices performed by a government agencyLoss or theft of an appliance or prosthesisTemporomandibular Joint Syndrome treatmentAny service not listed as specifically coveredProvider list is located online at www.pacifichealthalliance.comSubmit Claims To:Pacific Health AllianceGroup Number 602001525 Rollins Road, Suite BBurlingame, CA 94010-1814For questions call 1-800-533-4742** This is a summary of benefits. Please consult the Summary Plan Document for all provisions and limitationsof the dental plan.

MONTEREY COUNTY EMPLOYEE DENTAL PLANPROVIDER NETWORK 2019ALAMEDA COUNTYGeneral DentistryMostafa G.BarakzoyDDS38056 Martha AvenueFremont94536510 505-9409BUTTE COUNTYGeneral DentistryNavtej S.TatlaDDS1046 Mangrove Ave., Ste. DChico95926530 891-1674EndodonticsKimballBondDDS14147 Hereford DrChico95973530 345-6154Pleasant HillPleasant Hill9452394523925 689-5800925 689-5800CONTRA COSTA COUNTYPedodonticsJoseph T.VivieneRawlinsValdezDDSDDS675 Contra Costa Blvd675 Contra Costa BlvdEL DORADO COUNTYGeneral ill Dental Inc.GoodisRashidiSummerdykeDDSDDSDDSDMDDDS3350 Coach Lane4058 Flying C Rd., Ste. 9540 Main St., Ste. 1021204 Suncast Ln.4200 Mother Lode Dr.Cameron ParkCameron ParkDiamond SpringsEl DoradoShingle vid PKoehnDDS1158 Sun Cast Lane #1El Dorado Hills95762916 59559559559559559559559559TaftTaft9326893268661 763-5133661 763-5133North HollywoodSanta MonicaNorth HollywoodDiamond BarLomitaBaldwin ParkBurbankLos AngelesLos AngelesEl MonteLos AngelesLos 323FRESNO COUNTYGeneral DentistryLojynMohamedJoannEfemaVictoria C.HallakKaouMillerNwajeiPocasangreWestern DentalWestern Dental ServiceWestern Dental ServiceWestern Dental ServiceWestern Dental ServiceWestern Dental ServiceWestern Dental ServiceDDSDDSDDSDDSDDSDDSDDSDDSDDSDDSDDSDDS1550 Shaw Ave.1550 Shaw Ave1570 E. Herndon Ave.6767 N Fresno St, Suite 2001823 Shaw Ave., #1043920 North Cedar Ave751 W. Shaw Ave.4901 E. Kings Canyon Rd.4195 Shields Ave.4195 Shields Ave.3077 W. Shaw1255 W. Shields KERN COUNTYGeneral DentistryMichelleQuyenMartinezPhamDDSDDS103 Adkisson Way103 Adkisson WayLOS ANGELES COUNTYGeneral ll'OlmoKohanLeungTurkmaniWestern DentalWestern DentalWestern DentalWestern DentalWestern DentalWestern DentalWestern DentalDMDDDSDDSDDSDDSDDSDDSDDSDDSDDSDDSDDS13065 Victory Blvd.1304 15th Street # 31513065 Victory Blvd.20885 Golden Springs Dr.25332 Narbonne Avenue, #29014510 Baldwin Park Towne Center1400 West Olive Ave.3015 Crenshaw Blvd4900 Whittier Blvd11017 Valley Blvd1155 North Vermont Ave1357 East Florence 0748-2250733-0969780-0009582-4787461-9942835-0444

MONTEREY COUNTY EMPLOYEE DENTAL PLANPROVIDER NETWORK 2019OrthodonticsDanthanh H.JennifferWestern DentalWestern DentalWestern DentalWestern DentalWestern DentalWestern DentalWestern DentalWestern DentalWestern DentalWestern DentalDDSDDSDDSDDSDDSDDSDDSDDSDDSDDS10900 Long Beach Blvd10965 Firestone Blvd8214 Van Nuys Blvd14101 Paramount Blvd1127 East Green St20700 S. Avalon Blvd2700 Colorado Blvd Ste 26314119 Pioneer Blvd4444 Tweedy Blvd2700 Colorado Blvd Ste agle RockNorwalkSouth GateEagle 4-2444987-2175FieldsRojasDDSDMD2244 Fair Park Ave2244 Fair Park AveLos AngelesLos Angeles9004190041323 363-2244323 363-2244Merced95348209 ereySalinasMontereySalinasSalinasKing 1831831831831831831831831831MERCED COUNTYGeneral DentistryWestern Dental ServiceDDS1124 W. Olive Ave., #101MONTEREY COUNTYGeneral DentistryBrian S.Brian S.Brian S.Ayman K.ParulParulSashaWaelChadChadDennis R.Eric C.Theresa A.SharonSnehaSnehaRogelioAlanPreetiPreetiDavid P.Michael h B.Michael S.RandolphFideleJonParaonParaonJ. GriggRavneet ntBangra ManjeshwarBangra aChoChoCrossDe La TorreDeanDental SDDS668 East Romie Lane945 Blanco Circle, Suite D633 E. Alvin Drive, Suite B1717 Fremont Blvd656 Munras Ave.1229 N. Main Street921 S. Main Street, Suite A1010 Cass St., #C12440 Fremont St. Ste 2111124 Pajaro St.24551 Silver Cloud Ct. Ste 102750 E. Romie Ln. #B971 Pacific St.11 West Laurel Dr., Ste. 135971 Pacific St.1229 N. Main Street921 S. Mains Street, Suite A550 Canal St, #A640 E. Alvin Dr., Ste. D945 Blanco Circle, Ste D633 E. Alvin Dr, Ste B40 Dormody Ct.251 Lighthouse Ave.1211 South Main Street27859 Berwick Ave.770 E. Romie Lane Suite A-1620 E Alvin Drive1107 Los Palos Dr, Ste 4921 S. Main Street, Suite A1229 N. Main Street1760 N. Main St1760 N. Main St.29A Bishop Road3154 De Forest Rd., Ste. D920 Cass St, Ste 100160 Harden Parkway, #102929 N. Main Street1513 Fremont Blvd., Ste. E2408 S. Main St.1710 N. Main 24-4492424-7878200-4000

MONTEREY COUNTY EMPLOYEE DENTAL PLANPROVIDER NETWORK 2019MatthewJamieKarla YanovaSaschaMatthewAnuradhaAnuradhaNajiaRobert J.ReneGregoryTalaWilliamSang HoonTracyDelwinRichardKendallChristopherKristin AnnKristin AnnKristin athiq I.PreetiJignaJignaAnthonyHa eongYoungrimKellyKellyJonathanTony Kong ShingEdwardAdrianaShu YunnDonghoonWon K.DickSteveSteveJackMaurice TDoDominguezDuron de AldapeEmamiFreemanFriendly Smiles kiLa Paz Dental DSDDSDDSDDSDDSDDSDDSDDS100 Park Ave.672 East Romie Lane258 San Jose Street, Ste B921 S. Main Street, Suite A1293 Davis Street550 Canal St., #A1229 N. Main Street921 S. Main Street, Suite A10561 Merritt Street130 E. Romie Lane, Ste A921 S. Main Street, Suite A780 E. Romie Lane, Ste. B323 N Sanborn Rd Ste F11 W. Laurel Dr., #135851 5th St. Ste H1070 N. Davis Rd.110 Harden Pkwy., #1023154 De Forest Road, Ste. B223 Reindollar Avenue, Ste. B750 East Romie Lane, Suite A945 Blanco Circle, Suite D633 East Alvin Drive1717 Fremont Blvd.1070 N. Davis Rd.770 E. Romie Ln., Ste. B550 Canal Street, #A3154 De Forest Road Ste.D160 Harden Pwy Ste. 102329 El Camino Real329 El camino Real323 N. Sanborn Road, Ste. F329 El Camino Real10561 Merritt Street921 S. Main Street, Suite A1229 N. Main Street1070 N. Davis Rd.851 5th St., Ste. A463 Canyon Del Rey Blvd1970 North Main Street463 Canyon Del Ray Blvd851 5th St Ste H463 Canyon Del Rey Blvd851 5th St Ste H1970 North Main Street1070 N. Davis Rd.1137 N. Main Street, Ste A1229 N. Main Street921 S. Main Street, Suite A1556 N. Main St.29A Bishop Road880 Cass St., #207559 E. Alisal St., Ste. 10117820 Moro Road559 E. Alisal Street, Suite 101190 Kidder Street2030 California Ave.275 W. Laurel Dr., Ste. C921 S. Main Street, Suite A1229 N. Main Street505 E. Romie Lane, Ste. J633 E Alvin Dr. Ste BMontereySalinasSalinasSalinasSalinasKing linasSalinasSalinasSeasideSalinasSalinasKing ieldCastrovilleSalinasSalinasSalinasGonzalesDel Rey OaksSalinasDel Ray OaksGonzalesDel Rey d 24-6481443-1177

MONTEREY COUNTY EMPLOYEE DENTAL PLANPROVIDER NETWORK 2019Maurice TMaurice TFrankJonathanNguyenMoody W.RamiroRogelioKavithaMary AnneLindaKevin navalliAparnavalli C.Steven TAudreyKenMichael N.NgoctrinhThaoThaoJames S.RonaldoNecdetAugustoMaryChattanDhavalDhaval N.HarshitaTrushyapMarthaDavid M.ChonaBharatBharatSumanDavid M.Mark amsMecklerMikhailMirelesMirelesMission DentalModjeskiMoy (Cypress guyenNguyenNguyenOhOnus Dental telPatelPaynePerfect Smile DDSDDSDDSDDS945 Blanco Circle Ste D1717 Fremont Blvd620 E. Alvin Drive220 N. Vanderhurst Ave.1229 N. Main St631 East Alvin Dr. Ste. J-1620 E. Alvin Drive1033 E. Alisal St., Ste. H921 S. Main Street, Suite A880 Cass St., Ste. 20785 Vista Robles770 E Romie Lane #H920 Cass St, Ste 100631 E. Alvin Dr., Ste. J2696 Walnut Ave.608 E. Boronda Rd., #B2530 H. De La Rosa Sr. St.1293 Davis Street2240 N Fremont85 Via Robles770 E. Romie Lane., Ste. C1229 N. Main St1229 N. Main Street1229 N. Main Street921 S. Main Street, Suite A921 S. Main Street, Suite A1229 N. Main Street1089 S. Main St.1089 South Main St.972 Lupin Dr Ste B1229 N. Main Street1293 DAvis Street1542 N. Sanborn Road799 Front Street1229 N. Main Street921 S. Main Street, Suite A21 Upper Ragsdale, Ste 160408 S. Main St.921 S. Main Street, Suite A1229 N. Main Street1185 N. Main St., Ste. 11249 Fremont Blvd., Suite B652 E. Luarel Dr., #C921 S. Main Street, Suite A620 E. Alvin Dr., Ste. F640 E. Alvin Dr., Ste. A921 S. Main Street, Suite A750 E Romie Ln, Ste C631 E. Alvin Dr., Ste. J2222 S. Russ Street1064 Pajaro St.1070 N. Davis Rd., Ste. A-2601 E. Romie Ln., Ste. 4668 East Romie Lane421 Center Street110 Harden Pkwy., #1021976 N. Main St.921 S. Main Street, Suite A1229 N. Main Street1229 N. Main Street921 S. Main Street, Suite ASalinasSeasideSalinasKing alinasSalinasSalinasSalinasKing 783-3160

MONTEREY COUNTY EMPLOYEE DENTAL PLANPROVIDER NETWORK 2019Syed SajjadRaymondRaymondFranciscaGrantSteven T.AmarpreetKenji BennetKenji BennetKenji BennetLaneJafarMadhaviDavid D.TatshyanSumeetSumeetAntoniettaJulioSamiMallory uan CarlosPatricia YPatricia eidongWeidongMark A.Samuel C.BruceJoerg M.PhilipRobertSung-PinJenniferJenniferSeaside DentalSalinas DentalLesterPeterJamie uongTsaoTurTurValenciaVan KootenVan nWesleyWestern Dental ServiceWestern Dental n Dental CareWynn Dental CorpWynn Dental Corp.Wynn Dental DDSDDSDMD921 S. Main Street, Suite A696 Walnut Ave., #1608 E. Boronda Rd., #B1209 North Davis Rd.750 E. Romie Ln. #B750 E. Romie Lane., Ste. A505 E. Romie Lane, Suite J533 East Alvin Drive945 Blanco Circle, Suite D1717 Fremont Blvd.620 E. Alvin Dr., Ste. F2021-A North Main St.1229 N. Main Street21 Upper Ragsdale Dr., Ste. 170271 Reservation Rd Ste 1021130 Fremont Blvd, Ste 1061710 N. Main St.1104 N. Davis Road1004 N Davis Rd750 E Romie Ln, Ste C26365 Carmecl Rancho Blvd Ste D608 E. Boronda Rd., Ste. B243 El Dorado St., #1012530 H. De La Rosa SR. Street1229 N. Main Street668 East Romie Lane1229 N. Main Street921 S. Main Street, Suite A559 E. Alisal St., #101251 Lighthouse Ave251 Lighthouse Ave.640 E. Alvin Dr., Ste. D921 S. Main Street, Suite A1465-A North Davis Rd.1976 N. Main St.945 Blanco Circle Ste D.633 E. Alvin Dr. Suite B1717 Fremont Blvd.1229 N. Main Street921 S. Main Street, Suite A1229 N. Main Street921 S. Main Street, Suite A601 E. Romie Lane, Ste. 5929 North Main St.1229 N. Main St921 S. Main St., Ste. A122 San Antonio Drive160 Harden Parkway, Ste. 1023154 Deforest Road921 S. Main Street, Suite A921 S. Main Street, Suite A929 North Main St.1513 Fremont Blvd., Ste. E-21211 South Main St.1513 Fremont Blvd., #E-2929 N Main Street1513 Fremont Blvd., #E-21070 N. Davis Rd.11 Maple St., Suite E631 E. Alvin Drive, Suite E408 S Main linasSalinasSalinasSalinasSalinasKing 2222753-6598443-5801424-7878

MONTEREY COUNTY EMPLOYEE DENTAL PLANPROVIDER NETWORK 2019RobertRobert P.Ding 0 Harden Parkway, #102271 Reservation Road, Ste. 102808 Oak Avenue1229 N. Main EndodonticsFarnooshLillianBryan F.Sung-MingAbassiKaykhaMansourYoungMDDDSDDSDDS160 HArden Parkway Suite 1021001 Pacific St., Ste. E130 E. Romie Lane Ste. B668 East Romie l SurgeryWenNarbehNarbehAndresMichael K.Michael K.Ryan R.Ryan ajuPerry V.Perry DSDDS668 E Romie Lane1229 N. Main Street921 S. Main Street, Suite A420 East Romie Lane, Ste. A337 El Dorado St., #3A770 E. Romie Lane, #G337 El Dorado St., #3A770 E. Romie Lane, #G24551 Silver Cloud1124 Pajaro St.921 S. Main Street, Suite A1229 N. Main Street1229 N. Main St.24551 Silver Cloud1124 Pajaro St.1229 N. Main Street921 S. Main Street, Suite A668 East Romie Lane880 Cass St. Ste 203127 E. Romie Lane921 S. Main Street, Suite A1229 N. Main Street640 E. Alvin Drive, Ste. C160 Harden Pwy. Ste SDDSDDSDDSDDSDDSDDSDDSDDSDDSDDSDDSDDSDDS1293 Davis Road1293 Davis Road921 S. Main Street, Suite A921 S. Main Street, Suite A1229 N. Main Street1293 Davis Road1229 N. Main Street1293 Davis Road921 S. Main Street, Suite A921 S. Main Street, Suite A1293 Davis Road921 S. Main Street, Suite A1293 Davis Road921 S. Main Street, Suite A1293 Davis Road921 S. Main Street, Suite A1293 Davis Road921 S. Main Street, Suite A1293 Davis Road1229 N. Main Street921 S. Main Street, Suite A1293 Davis Road1229 N. Main 600442-8000783-3170442-7600442-8000

MONTEREY COUNTY EMPLOYEE DENTAL PLANPROVIDER NETWORK ooYooDDSDDSDDSDDSDDSDDS1293 Davis Road921 S. Main Street, Suite A1976 N. Main St.921 S. Main Street, Suite A921 S. Main Street, Suite A1293 Davis icsJohn K.John K.John K.John K.PeterPeterPeterPeterMatthew C.ShiowShiowShiowTeresaTeresaTeresaJamie Yuen YinJennifer DawnJennifer DawnJennifer DawnJennifer DawnPaul J.Paul JosephPaul JosephPaul eth L.CharlesCharles EdwinCharles EdwinCharles EdwinKenji B.Roger GregoryRoger GregoryJamie Yuen YinJamie Yuen DDS945 Blanco Circle, Ste. D633 E. Alvin Dr., Ste. B631 E. Alvin Drive, Suite E1717 Fremont Blvd.945 Blanco Circle, Suite D633 East Alvin Drive631 E. Alvin Drive, Suite E1717 Fremont Blvd.631 E. Alvin Drive, Suite E945 Blanco Circle, Ste D633 E Alvin Drive1717 Fremont Blvd945 Blanco Circle, #D633 E. Alvin Dr., #B1717 Fremont Blvd.1717 Fremont Blvd.945 Blanco Circle, Suite D633 East Alvin Drive631 E. Alvin Drive, Suite E1717 Fremont Blvd.631 E. Alvin Drive, Suite E633 East Alvin Drive945 Blanco Circle, Suite D1717 Fremont Blvd.945 Blanco Circle, Suite D633 East Alvin Dr.631 E. Alvin Drive, Suite E1717 Fremont Blvd.945 Blanco Circle Ste D633 E. Alvin Dr. Suite B1717 Fremont Blvd.633 E Alvin Dr., Ste. B945 Blanco Circle, Ste. D1717 Fremont Blvd.633 E Alvin Dr., Ste. B945 Blanco Circle, Ste. D1717 Fremont Blvd.631 E. Alvin Drive, Suite E631 E. Alvin Drive, Suite E633 East Alvin Drive945 Blanco Circle, Suite D1717 Fremont Blvd.631 E. Alvin Drive, Suite E633 East Alvin Dr.1717 Fremont Blvd.633 E Alvin Dr., Ste. B945 Blanco Circle, Ste. SDDSDDS921 S. Main Street, Suite A1229 N. Main Street921 S. Main Street, Suite A921 S. Main Street, Suite 31831831831783-3160442-8000783-3160783-3160

MONTEREY COUNTY EMPLOYEE DENTAL PLANPROVIDER NETWORK 2019IyadIsraelSoodTrujilloDDSDDS921 S. Main Street, Suite A160 Harden Parkway, Suite 102SalinasSalinas9390193906831 783-3160831 1001 Pacific Street, Ste. B951 Blanco Circle, Ste. CMontereySalinas9394093901831 443-5801831 443-5801Napa94558707 501-5030FullertonMission ViejoMission le95661916 773-6222RiversideRiversideIndian ntoFolsom9583195630916 594-9474916 1831831408831831831831NAPA COUNTYGeneral DentistryWestern Dental ServiceDDS1260 Trancas St.ORANGE COUNTYGeneral DentistryChris C.Ada M.ShadiChunzhuChungGruitaRadYuDDSDDSDDSDDS506 W. Commonwealth Ave.27680 Santa Margarita Pkwy24000 Alicia Parkway, Ste 341500 East Katella Ave., Suite L738-7777525-8238707-7000538-5877PLACER COUNTYGeneral DentistryEhsan SonnyAfsharDDS2030 Douglas Blvd., #37RIVERSIDE COUNTYGeneral DentistryHarshJose JoelMallory AKalyaniManaleseStechishinWestern DentalDDSDDSDDSDDS17024 Van Buren Blvd. Ste. B3950 Pierce St. Suite L74-900 Hwy 111 Ste 2001688 N. Perris Blvd892-0022688-0082568-2000688-9363SACRAMENTO COUNTYGeneral DentistryAngel J.YulyPintoVildermanDDSDDS925 Secret River Dr. Ste. A1840 Prairie City Rd., Ste 200SAN BENITO COUNTYGeneral DentistryVirginiaDavid P.ToddVuppala LingaTerry W.GregDavid phensTranVuppalaDDSDDSDDSDDSDDSDDSDDSDDS345 5th St.920 Sunset Dr.1710 Memorial Dr., Ste. B893 Sunset Drive901 Sunset Dr., #5261 B McCray St., Ste. A893 Sunset HollisterHollisterHollisterOral SurgeryGaryPritchettDDS930 Sunnyslope Road, B-3Hollister95023831 637-4627Chino91910909 591-0077Chula VistaEncinoCarlsbadChula 1SAN BERNARDINO COUNTYPedodonticsLindaTranDDS3991 Grand Ave., #DSAN DIEGO COUNTYGeneral DentistryDavid M.MaryamMegan DMDDDS885 Canarios Ct. Ste 21016661 Ventura Blvd., #2083144 El Camino Real Ste #103885 Canarios Ct. Ste 210SAN JOAQUIN COUNTYGeneral Dentistry656-4199646-0194434-9800656-4199

MONTEREY COUNTY EMPLOYEE DENTAL PLANPROVIDER NETWORK 2019PedodonticsJosephWestern Dental ServiceWestern Dental ServiceWestern Dental ServiceWestern Dental ServiceWestern Dental ServiceWestern Dental ServiceWestern Dental ServiceDDSDDSDDSDDSDDSDDSDDS320 S. Cherokee Lane1332 E. Yosemite Ave., Ste. F1160 W. Yosemite Ave., #F7860 West Lane, Ste. B1407 W. March Lane678 N. Wilson Way, #D2313 N. Corral Hollow -9000832-9530RawlinsDDS569 W Lowell Avenue # 200Tracy95376209 832-5800Atascadero93422805 461-1182SAN LUIS OBISPO COUNTYPedodonticsDavidCottrellDDS4260 El Camino RealSAN MATEO COUNTYGeneral DentistryQuan LiSurgeryAlfredo AArchstone Oral & FacialDo

Western Dental DDS 1127 East Green St Pasadena 91106 626 389-2570 Western Dental DDS 20700 S. Avalon Blvd Carson 90746 310 241-6175 Western Dental DDS 2700 Colorado Blvd Ste 263 Eagle Rock 90041 323 987-2175 Western Dental DDS 14119 Pioneer Blvd Norwalk 90650 562 929-2383 Western Dental DDS 4444 Tweedy Blvd South Gate 90280 323 564-2444

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