Provider Demographics
NPI:1922396183
Name:JUSTEMA, ROSALEE ANN BEREDO (DDS)
Entity Type:Individual
Prefix:
First Name:ROSALEE
Middle Name:ANN BEREDO
Last Name:JUSTEMA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 N UNIVERSITY AVE
Mailing Address - Street 2:PEDIATRIC DENTISTRY CLINIC-2ND FLOOR
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-1085
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 N UNIVERSITY AVE
Practice Address - Street 2:PEDIATRIC DENTISTRY CLINIC
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-1085
Practice Address - Country:US
Practice Address - Phone:734-764-1523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist