Healthcare Provider Details

I. General information

NPI: 1730253212
Provider Name (Legal Business Name): PAUL J STYRT D.M.D.,M.P.H.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 EXECUTIVE DR PLAZA SUITE 3
SAN DIEGO CA
92121-3021
US

IV. Provider business mailing address

4510 EXECUTIVE DR PLAZA SUITE 3
SAN DIEGO CA
92121-3021
US

V. Phone/Fax

Practice location:
  • Phone: 858-458-1088
  • Fax:
Mailing address:
  • Phone: 858-458-1088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number34226
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number34226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: