Provider Demographics
NPI:1053324772
Name:NAYLOR, JUSTIN NATHANAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:NATHANAEL
Last Name:NAYLOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA631201223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics