Provider Demographics
NPI:1326939703
Name:CAPILITAN, CHARLES JUSTIN TRINIDAD (DDS)
Entity type:Individual
Prefix:
First Name:CHARLES JUSTIN
Middle Name:TRINIDAD
Last Name:CAPILITAN
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 1:17180 BEAR VALLEY RD STE A
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5880
Mailing Address - Country:US
Mailing Address - Phone:760-558-5437
Mailing Address - Fax:
Practice Address - Street 1:17180 BEAR VALLEY RD STE A
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5880
Practice Address - Country:US
Practice Address - Phone:760-558-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist