Provider Demographics
NPI:1205803566
Name:OPSAHL, CARL ERIK (DDS)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:ERIK
Last Name:OPSAHL
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 1:2888 W PORTER RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-6083
Mailing Address - Country:US
Mailing Address - Phone:619-524-4014
Mailing Address - Fax:
Practice Address - Street 1:43000 MIDWAY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92140-5692
Practice Address - Country:US
Practice Address - Phone:619-524-4009
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA321591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice