Provider Demographics
NPI:1437590593
Name:JUSTESEN, STEVEN BLAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:BLAINE
Last Name:JUSTESEN
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 1:1125 W KAGY BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5879
Mailing Address - Country:US
Mailing Address - Phone:406-587-2201
Mailing Address - Fax:406-587-0880
Practice Address - Street 1:1125 W KAGY BLVD STE 303
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5879
Practice Address - Country:US
Practice Address - Phone:406-587-2201
Practice Address - Fax:406-587-0880
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-45111223G0001X
WADE604765661223G0001X
MTDEN-DEN-LIC-134221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice