MEDICARE: DR. CHRISTOPHER JUSTIN MICU

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	D012821	AZ

General Provider Information

NPI Number	:	1912839580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER JUSTIN MICU

Provider Business Mailing Address
First Line	:	5422 W THUNDERBIRD RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4700
Country	:	US
Telephone Number	:	480-564-4957
Fax Number	:

Provider Business Practice Location Address
First Line	:	5422 W THUNDERBIRD RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4700
Country	:	US
Telephone Number	:	480-564-4957
Fax Number	:

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

Provider Enumeration Date	:	05/30/2026
Last Update Date	:	05/30/2026

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