Provider Demographics
NPI:1275308207
Name:JUSTUS DENTAL, HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:JUSTUS DENTAL, HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LATHONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:912-996-3303
Mailing Address - Street 1:PO BOX 1010
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-1010
Mailing Address - Country:US
Mailing Address - Phone:912-996-3303
Mailing Address - Fax:866-379-9998
Practice Address - Street 1:5321 US HWY 521
Practice Address - Street 2:
Practice Address - City:SALTERS
Practice Address - State:SC
Practice Address - Zip Code:29590
Practice Address - Country:US
Practice Address - Phone:843-800-0087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUSTUS COMMUNITY PERPETUALIZATION PROJECT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness Coach
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No292200000XLaboratoriesDental Laboratory
No332900000XSuppliersNon-Pharmacy Dispensing Site