Provider Demographics
NPI:1538879648
Name:JUSTUS DENTAL HEALTH AND WELLNESS
Entity type:Organization
Organization Name:JUSTUS DENTAL HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LATHONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:912-996-3303
Mailing Address - Street 1:PO BOX 1010
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-1010
Mailing Address - Country:US
Mailing Address - Phone:912-996-3303
Mailing Address - Fax:866-379-9998
Practice Address - Street 1:137 BROUGHTON AVE
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:SC
Practice Address - Zip Code:29510-5583
Practice Address - Country:US
Practice Address - Phone:912-996-3303
Practice Address - Fax:866-379-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health