Active NPI
Bryce E. Justesen, DDS
- Dentist
- Mesa, AZ
National Provider Identifier
1013020502
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D2731
- Practice address
- 2830 E Brown Rd
Suite 6
Mesa, AZ 85213-5430 - Phone
- (480) 835-5945
- Fax
- (480) 890-2176
- NPI assigned
- Aug 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D2731 | AZ | Primary |
Addresses
Primary practice location
2830 E Brown Rd
Suite 6
Mesa, AZ 85213-5430
Mailing address
946 E. Hackamore
St.
Mesa, AZ 85203
Phone (480) 835-5945
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D2731 | AZ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013020502",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "946 E. HACKAMORE",
"address_2": "ST.",
"city": "MESA",
"state": "AZ",
"postal_code": "85203",
"telephone_number": "480-835-5945",
"fax_number": "480-890-2176"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2830 E BROWN RD",
"address_2": "SUITE 6",
"city": "MESA",
"state": "AZ",
"postal_code": "852135430",
"telephone_number": "480-835-5945",
"fax_number": "480-890-2176"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUSTESEN",
"first_name": "BRYCE",
"middle_name": "E.",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "D2731",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.