Provider Demographics
NPI:1124639562
Name:DUNSFORD, PHILLIP JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:JAMES
Last Name:DUNSFORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 10TH AVE UNIT 411
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7268
Mailing Address - Country:US
Mailing Address - Phone:831-224-7161
Mailing Address - Fax:
Practice Address - Street 1:2310 CRAVEN ST BLDG 3230
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-5596
Practice Address - Country:US
Practice Address - Phone:831-224-7161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11887236-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice