MEDICARE: JUSTIN WATERS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1023827391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUSTIN WATERS PLLC

Provider Business Mailing Address
First Line	:	8390 E VIA DE VENTURA STE F200
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-3177
Country	:	US
Telephone Number	:	480-466-6399
Fax Number	:

Provider Business Practice Location Address
First Line	:	8390 E VIA DE VENTURA STE F200
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-3177
Country	:	US
Telephone Number	:	480-466-6399
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JUSTIN JAMES WATERS
Credential	:	DMD
Telephone Number	:	480-400-5000

Provider Enumeration Date	:	01/02/2025
Last Update Date	:	01/02/2025

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