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General NPI Number Information
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NPI Number | 1558922864
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Entity Type | Individual
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Provider Name | JUSTIN JOSEPH DDS
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Gender | Male
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 102 WHEATFIELD DR STE D
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City | MILFORD
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State | PA
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Zip | 18337-7695
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Country | US
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Telephone | 570-296-2259
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Fax |
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Provider Business Mailing Address
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Address Line | 102 WHEATFIELD DR. SUITE D
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City | MILFORD
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State | PA
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Zip | 18337
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Country | US
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Telephone | 570-296-2259
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Fax | 570-296-9475
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS043029
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License Number State | PA
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