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General NPI Number Information
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NPI Number | 1962618421
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Entity Type | Individual
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Provider Name | JOHN MICHAEL JUSTUS DDS
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Gender | Male
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 450 CLEVELAND AVE
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City | LOVELAND
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State | CO
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Zip | 80537-5508
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Country | US
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Telephone | 970-461-8942
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Fax |
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Provider Business Mailing Address
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Address Line | 14693 E PURDUE PL
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City | AURORA
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State | CO
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Zip | 80014-7149
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Country | US
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Telephone | 720-987-3173
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5551
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License Number State | CO
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