=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932116571
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL G JUSTICE DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 VANDERBUILT PARK DR STE 250
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-277-5230
-----------------------------------------------------
Fax | 828-277-5614
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 VANDERBUILT PARK DR STE 250
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-277-5230
-----------------------------------------------------
Fax | 828-277-5614
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL G JUSTICE
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 828-277-5230
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | NC4214
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------