Provider Demographics
NPI:1881854701
Name:SJULSON, JUSTIN D (DDS)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:D
Last Name:SJULSON
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 1:12002 PACIFIC AVE S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-5117
Mailing Address - Country:US
Mailing Address - Phone:253-531-5700
Mailing Address - Fax:
Practice Address - Street 1:12002 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-5117
Practice Address - Country:US
Practice Address - Phone:253-531-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6255122300000X
WADE60440593122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist