Provider Demographics
NPI:1285294561
Name:HOSSEINI, JUSTIN (DMD MS)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:HOSSEINI
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 SUNRISE KEY BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3826
Mailing Address - Country:US
Mailing Address - Phone:954-448-9072
Mailing Address - Fax:
Practice Address - Street 1:1040 WESTON RD STE 225
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-1912
Practice Address - Country:US
Practice Address - Phone:954-389-9500
Practice Address - Fax:954-384-1045
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24328122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist