Provider Demographics
NPI:1619049012
Name:GEE, JUSTIN (DMD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:GEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MISSION CIR
Mailing Address - Street 2:STE 101
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-5398
Mailing Address - Country:US
Mailing Address - Phone:707-537-0550
Mailing Address - Fax:707-537-0660
Practice Address - Street 1:55 MISSION CIR
Practice Address - Street 2:STE 101
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-5398
Practice Address - Country:US
Practice Address - Phone:707-537-0550
Practice Address - Fax:707-537-0660
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212311223G0001X
CA561631223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice