Provider Demographics
NPI:1477725323
Name:LEROY JUSTICE DDS,PC
Entity Type:Organization
Organization Name:LEROY JUSTICE DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:706-444-6886
Mailing Address - Street 1:12900 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:GA
Mailing Address - Zip Code:31087-1737
Mailing Address - Country:US
Mailing Address - Phone:706-444-6886
Mailing Address - Fax:706-444-7779
Practice Address - Street 1:12900 BROAD STREET
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:GA
Practice Address - Zip Code:31087-1737
Practice Address - Country:US
Practice Address - Phone:706-444-6886
Practice Address - Fax:706-444-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty