Provider Demographics
NPI:1235280553
Name:JUSTUS, MATTHEW S (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:S
Last Name:JUSTUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28000 JAY ROAD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150
Mailing Address - Country:US
Mailing Address - Phone:313-561-9030
Mailing Address - Fax:313-565-8494
Practice Address - Street 1:28000 JAY ROAD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150
Practice Address - Country:US
Practice Address - Phone:313-561-9030
Practice Address - Fax:313-565-8494
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010147661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice