Provider Demographics
NPI:1457554107
Name:JUSTICE, MICHAEL G (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:JUSTICE
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:ONE VANDERBILT PARK DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803
Mailing Address - Country:US
Mailing Address - Phone:828-277-5230
Mailing Address - Fax:828-277-5614
Practice Address - Street 1:ONE VANDERBILT PARK DR
Practice Address - Street 2:SUITE 250
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803
Practice Address - Country:US
Practice Address - Phone:828-277-5230
Practice Address - Fax:828-277-5614
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8994753Medicaid