MEDICARE: JUSTINA JEAN AHN 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	122300000X	Dentist	14035483-9926	UT
2	122300000X	Dentist	14035483-8903	UT

General Provider Information

NPI Number	:	1003645904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINA JEAN AHN DMD

Provider Business Mailing Address
First Line	:	2817 ROCK MERRITT AVE
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 ROCK MERRITT AVE
Second Line	:
City	:	FORT BRAGG
State	:	NC
Zip	:	28310-4613
Country	:	US
Telephone Number	:	910-907-8922
Fax Number	:	910-907-6069

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

Provider Enumeration Date	:	07/29/2024
Last Update Date	:	09/06/2025

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