MEDICARE: DR. JUSTIN JAMES WATERS DMD

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	1223G0001X	General Practice Dentistry	D011096	AZ

General Provider Information

NPI Number	:	1871267385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN JAMES WATERS DMD

Provider Business Mailing Address
First Line	:	7340 E LEGACY BLVD UNIT E3007
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-6396
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	:	480-400-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2021
Last Update Date	:	02/14/2025

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