Provider Demographics
NPI:1093554677
Name:JUSTIN N NAYLOR DDS PROFESSIONAL DENTAL CORP
Entity type:Organization
Organization Name:JUSTIN N NAYLOR DDS PROFESSIONAL DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:NAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-755-4787
Mailing Address - Street 1:12264 EL CAMINO REAL STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3061
Mailing Address - Country:US
Mailing Address - Phone:858-755-4787
Mailing Address - Fax:858-755-7704
Practice Address - Street 1:12264 EL CAMINO REAL STE 206
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3061
Practice Address - Country:US
Practice Address - Phone:858-755-4787
Practice Address - Fax:858-755-7704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053324772OtherENDODONTIC SPECIALTY OFFICE