Provider Demographics
NPI:1336309723
Name:DEXTER, JUSTIN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MICHAEL
Last Name:DEXTER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5100 W TAFT RD
Mailing Address - Street 2:SUITE 4M
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3807
Mailing Address - Country:US
Mailing Address - Phone:315-362-3937
Mailing Address - Fax:315-458-7818
Practice Address - Street 1:5100 W TAFT RD
Practice Address - Street 2:SUITE 4M
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3807
Practice Address - Country:US
Practice Address - Phone:315-362-3937
Practice Address - Fax:315-458-7818
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2013-12-23
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Provider Licenses
StateLicense IDTaxonomies
NY260483207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ300045365Medicare PIN