Individual
JUSTIN IM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
18564 US HIGHWAY 18 STE 301, APPLE VALLEY, CA 92307-2340
(079) 076-0490
Mailing address
THIRD AVE. AND 183RD STREET, BRONX, NY 10457
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
106857
CA
Other
Enumeration date
04/28/2021
Last updated
04/04/2024
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