Provider Demographics
NPI:1114403094
Name:NAMM, JUSTIN (DDS)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:NAMM
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 1:1400 BARTON RD APT 3106
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5445
Mailing Address - Country:US
Mailing Address - Phone:248-767-9044
Mailing Address - Fax:
Practice Address - Street 1:1821 S SAN JACINTO AVE # STUDIOD
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5608
Practice Address - Country:US
Practice Address - Phone:951-654-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1026921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice