# LA JOLLA DENTAL SPECIALTY GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316171937
- **Authorized official:** DUKE HUYNH NGUYEN D.D.S (OWNER)
- **Authorized official phone:** (858) 546-1802

## Contact information

- **Practice address:** 4510 EXECUTIVE DR, SUITE 205, SAN DIEGO, CA 92121-3021
- **Practice address phone:** (858) 546-1802
- **Practice address fax:** (858) 546-1242
- **Mailing address:** 4510 EXECUTIVE DR, SUITE 205, SAN DIEGO, CA 92121-3021
- **Mailing address phone:** (858) 546-1802
- **Mailing address fax:** (858) 546-1242

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 47399 | CA | Yes |

## Other

- **Enumeration date:** 05/11/2009
- **Last updated:** 05/11/2009