MEDICARE: JUSTENE DOAN DENTAL, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1801617162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUSTENE DOAN DENTAL, PC

Provider Business Mailing Address
First Line	:	3780 EL CAJON BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1080
Country	:	US
Telephone Number	:	619-265-6877
Fax Number	:

Provider Business Practice Location Address
First Line	:	3780 EL CAJON BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1080
Country	:	US
Telephone Number	:	619-265-6877
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JUSTENE DOAN
Credential	:	DDS
Telephone Number	:	619-265-6877

Provider Enumeration Date	:	10/21/2024
Last Update Date	:	10/21/2024

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