Provider Demographics
NPI:1730638321
Name:BORTZ, JUSTIN ALLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ALLEN
Last Name:BORTZ
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 1:8160 S HOUGHTON RD
Mailing Address - Street 2:STE 130
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-4706
Mailing Address - Country:US
Mailing Address - Phone:520-663-4089
Mailing Address - Fax:
Practice Address - Street 1:8160 S HOUGHTON RD
Practice Address - Street 2:STE 130
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-4706
Practice Address - Country:US
Practice Address - Phone:520-663-4089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-24
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0095731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice