Provider Demographics
NPI:1275616872
Name:JUST, JEFFERY KEITH
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:KEITH
Last Name:JUST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E REED AVE
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-2123
Mailing Address - Country:US
Mailing Address - Phone:920-682-7616
Mailing Address - Fax:920-682-4361
Practice Address - Street 1:340 E REED AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2123
Practice Address - Country:US
Practice Address - Phone:920-682-7616
Practice Address - Fax:920-682-4361
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39999-0151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics