Provider Demographics
NPI:1083640882
Name:CHISARI, JUSTIN R (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:R
Last Name:CHISARI
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 COMMERCE LN
Mailing Address - Street 2:SUITE 5
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5598
Mailing Address - Country:US
Mailing Address - Phone:561-575-3634
Mailing Address - Fax:561-575-4364
Practice Address - Street 1:1928 COMMERCE LN
Practice Address - Street 2:SUITE 5
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5598
Practice Address - Country:US
Practice Address - Phone:561-575-3634
Practice Address - Fax:561-575-4364
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN175361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics