Individual
DR. BRAD D. JUSTESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2120 W GUADALUPE RD, #5, MESA, AZ 85202-7366
(480) 839-0985
(480) 730-8631
Mailing address
2120 W GUADALUPE RD, #5, MESA, AZ 85202-7366
(480) 839-0985
(480) 730-8631
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2566
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86-0471157
TAX ID
—
Enumeration date
01/15/2007
Last updated
06/02/2015
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