Provider Demographics
NPI:1760505440
Name:CATHERS, JUSTIN W (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:W
Last Name:CATHERS
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2323 S WADSWORTH BLVD
Mailing Address - Street 2:#104
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-3275
Mailing Address - Country:US
Mailing Address - Phone:303-984-9700
Mailing Address - Fax:303-985-2490
Practice Address - Street 1:2323 S WADSWORTH BLVD
Practice Address - Street 2:#104
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-3275
Practice Address - Country:US
Practice Address - Phone:303-984-9700
Practice Address - Fax:303-985-2490
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY053438122300000X
CO83321223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38371847Medicaid