Provider Demographics
NPI:1568756500
Name:DR. PAUL J. STYRT D.M.D., M.P.H., M.S.
Entity Type:Organization
Organization Name:DR. PAUL J. STYRT D.M.D., M.P.H., M.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:STYRT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MPH, MS
Authorized Official - Phone:858-458-1088
Mailing Address - Street 1:4510 EXECUTIVE DR
Mailing Address - Street 2:PLAZA SUITE 3
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3021
Mailing Address - Country:US
Mailing Address - Phone:858-458-1088
Mailing Address - Fax:858-458-1106
Practice Address - Street 1:4510 EXECUTIVE DR
Practice Address - Street 2:PLAZA SUITE 3
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3021
Practice Address - Country:US
Practice Address - Phone:858-458-1088
Practice Address - Fax:858-458-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty