Provider Demographics
NPI:1588794390
Name:CATALON, PHILLIP J (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:J
Last Name:CATALON
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 1:3080 MARLOW RD
Mailing Address - Street 2:SUITE A-7
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-7912
Mailing Address - Country:US
Mailing Address - Phone:707-578-2000
Mailing Address - Fax:707-578-0133
Practice Address - Street 1:3080 MARLOW RD
Practice Address - Street 2:SUITE A-7
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-7912
Practice Address - Country:US
Practice Address - Phone:707-578-2000
Practice Address - Fax:707-578-0133
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB39380-011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice