Individual
DR. JUSTIN JON PHILLIP CARL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1225 ISLAND AVE UNIT 204, SAN DIEGO, CA 92101-7567
(209) 406-4508
Mailing address
9118 PIMPERNEL DR, SAN DIEGO, CA 92129-3602
(209) 406-4508
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
61913
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
61913
CA
Other
Enumeration date
01/31/2013
Last updated
06/10/2021
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