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General NPI Number Information
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NPI Number | 1346643319
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Entity Type | Organization
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Legal Business Name | JUSTIN SYCAMORE DDS
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Dates
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Enumeration Date | 10/03/2014
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Last Update Date | 10/03/2014
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Provider Practice Location Address
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Address Line | 777 E THOUSAND OAKS BLVD
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-6054
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Country | US
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Telephone | 805-777-0050
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Fax | 805-777-0040
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Provider Business Mailing Address
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Address Line | 777 E THOUSAND OAKS BLVD
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-6054
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Country | US
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Telephone | 805-777-0050
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Fax | 805-777-0040
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Authorized Official
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Title or Position | DENTIST
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Name | JUSTIN SYCAMORE
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Credential | DDS
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Telephone | 805-777-0050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 59913
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License Number State | CA
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