Provider Demographics
NPI:1689455008
Name:FIRTH, JUSTIN M (DMD)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:M
Last Name:FIRTH
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Gender:M
Credentials:DMD
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Mailing Address - Street 1:5524 TELEGRAPH ROAD
Mailing Address - Street 2:UNIT 101
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129
Mailing Address - Country:US
Mailing Address - Phone:314-487-1141
Mailing Address - Fax:314-487-1146
Practice Address - Street 1:3890 S LINDBERGH
Practice Address - Street 2:#115
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127
Practice Address - Country:US
Practice Address - Phone:314-843-5553
Practice Address - Fax:314-487-1146
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-17
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Provider Licenses
StateLicense IDTaxonomies
MO20210203541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics