Healthcare Provider Details

I. General information

NPI: 1093554677
Provider Name (Legal Business Name): JUSTIN N NAYLOR DDS PROFESSIONAL DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12264 EL CAMINO REAL STE 206
SAN DIEGO CA
92130-3061
US

IV. Provider business mailing address

12264 EL CAMINO REAL STE 206
SAN DIEGO CA
92130-3061
US

V. Phone/Fax

Practice location:
  • Phone: 858-755-4787
  • Fax: 858-755-7704
Mailing address:
  • Phone: 858-755-4787
  • Fax: 858-755-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JUSTIN N NAYLOR
Title or Position: ENDODONTIST/OWNER
Credential: DDS
Phone: 858-755-4787