Provider Demographics
NPI:1548338858
Name:JUSTIS, DANIEL HUGO (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HUGO
Last Name:JUSTIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:H
Other - Last Name:JUSTIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1508 N GRANDVIEW
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761
Mailing Address - Country:US
Mailing Address - Phone:432-367-6988
Mailing Address - Fax:
Practice Address - Street 1:1508 N GRANDVIEW
Practice Address - Street 2:SUITE 5
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761
Practice Address - Country:US
Practice Address - Phone:432-367-6988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX138991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice