Individual
JUSTIN RAY MACKERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1322 N COOPER RD, GILBERT, AZ 85233-1903
(480) 626-0262
Mailing address
1322 N COOPER RD, GILBERT, AZ 85233-1903
(480) 626-0262
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
12840183-9921
UT
1223P0700X
Prosthodontics
Primary
D011298
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/07/2019
Last updated
01/05/2024
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