Healthcare Provider Details

I. General information

NPI: 1164399283
Provider Name (Legal Business Name): JUST ORTHODONTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E REED AVE # 54220
MANITOWOC WI
54220-2123
US

IV. Provider business mailing address

340 E REED AVE # 54220
MANITOWOC WI
54220-2123
US

V. Phone/Fax

Practice location:
  • Phone: 920-682-7616
  • Fax: 920-682-4361
Mailing address:
  • Phone: 920-682-7616
  • Fax: 920-682-4361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JEFFERY JUST
Title or Position: DOCTOR/
Credential: DDS
Phone: 920-682-7616