Provider Demographics
NPI:1972882140
Name:PERRY S JUSTICE JR DDS PA
Entity Type:Organization
Organization Name:PERRY S JUSTICE JR DDS PA
Other - Org Name:JUSTICE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-873-8899
Mailing Address - Street 1:2575 MAHOGANY LN
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-9312
Mailing Address - Country:US
Mailing Address - Phone:704-873-8899
Mailing Address - Fax:704-294-9914
Practice Address - Street 1:2117 SIMONTON RD
Practice Address - Street 2:SUITE 403
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-8206
Practice Address - Country:US
Practice Address - Phone:704-873-8899
Practice Address - Fax:704-873-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty