Provider Demographics
NPI:1033186556
Name:DUTTON, JUSTIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:DUTTON
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 1:15920 S RANCHO SAHUARITA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-8013
Mailing Address - Country:US
Mailing Address - Phone:520-838-0600
Mailing Address - Fax:
Practice Address - Street 1:15920 S RANCHO SAHUARITA BLVD
Practice Address - Street 2:SUITE ONE HUNDRED
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-8012
Practice Address - Country:US
Practice Address - Phone:520-838-0600
Practice Address - Fax:520-838-0865
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5385122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZODB23DUTTJU1Medicaid
AZ582579Medicaid