Provider Demographics
NPI:1992317143
Name:DOLE, JUSTIN S (DMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:S
Last Name:DOLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17767 N SCOTTSDALE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6590
Mailing Address - Country:US
Mailing Address - Phone:602-666-5805
Mailing Address - Fax:
Practice Address - Street 1:17767 N SCOTTSDALE RD STE 110
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6590
Practice Address - Country:US
Practice Address - Phone:602-666-5805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist