Provider Demographics
NPI:1609176478
Name:KEYASHIAN, JUSTIN MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MARK
Last Name:KEYASHIAN
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 1:1132 MAGGIE LN
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2568
Mailing Address - Country:US
Mailing Address - Phone:424-288-9830
Mailing Address - Fax:
Practice Address - Street 1:106 LA CASA VIA
Practice Address - Street 2:280
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3086
Practice Address - Country:US
Practice Address - Phone:925-932-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59820122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist