MEDICARE: DR. CHRISTOPHER STEVEN KENNETH JUSTEMA D.D.S.

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	1223G0001X	General Practice Dentistry	2901020462	MI

General Provider Information

NPI Number	:	1316232655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER STEVEN KENNETH JUSTEMA D.D.S.

Provider Business Mailing Address
First Line	:	15249 GRAND OAK DR
Second Line	:
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-9162
Country	:	US
Telephone Number	:	616-402-1761
Fax Number	:

Provider Business Practice Location Address
First Line	:	5978 HARVEY ST
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49444-6720
Country	:	US
Telephone Number	:	231-799-0404
Fax Number	:

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

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	01/17/2013

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