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NPI Code Detail

MEDICARE: DR. BRAD D. JUSTESEN D.D.S.

MEDICARE: DR. BRAD D. JUSTESEN 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
11223G0001XGeneral Practice Dentistry2566AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
186-0471157OTHERTAX ID

General Provider Information

NPI Number : 1558412734
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRAD D. JUSTESEN D.D.S.
Provider Business Mailing Address
First Line : 2120 W GUADALUPE RD
Second Line : #5
City : MESA
State : AZ
Zip : 85202-7366
Country : US
Telephone Number : 480-839-0985
Fax Number : 480-730-8631
Provider Business Practice Location Address
First Line : 2120 W GUADALUPE RD
Second Line : #5
City : MESA
State : AZ
Zip : 85202-7366
Country : US
Telephone Number : 480-839-0985
Fax Number : 480-730-8631
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2007
Last Update Date : 06/02/2015

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