Provider Demographics
NPI:1316232655
Name:JUSTEMA, CHRISTOPHER STEVEN KENNETH (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:STEVEN KENNETH
Last Name:JUSTEMA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15249 GRAND OAK DR
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-9162
Mailing Address - Country:US
Mailing Address - Phone:616-402-1761
Mailing Address - Fax:
Practice Address - Street 1:5978 HARVEY ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-6720
Practice Address - Country:US
Practice Address - Phone:231-799-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010204621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice