Justin Church, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D 7892 Issued in AZ

Practice address

2540 S 4TH Ave
Yuma, AZ 85364-7286

Phone

(480) 206-0139

NPI assigned

Sep 3, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Justin Church DMD PLC

  • Dental Clinic/Center
  • Yuma, AZ
  • NPI 1174824619
  NPD (past) Authorized official
• Yuma Dental LLC

  • Preferred Provider Organization
  • Yuma, AZ
  • NPI 1043652910
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288828800000",
    "number": "1184857419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2540 S 4TH AVE",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853647286",
            "telephone_number": "480-206-0139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2540 S 4TH AVE",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853647286",
            "telephone_number": "480-206-0139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCH",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-03",
        "last_updated": "2010-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D 7892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney C Christ, DPT
• Christopher R. Moor, M.D., P.C.
• Natakom Nash Chulamorkodt, MD
• Aaron J. Chun, M.D.
• Mahealani Carla Chun, SLPA
• Kipp Owens Church, D.M.D
• Jodie Cicco, PT, DPT
• City of Yuma
• Christianna J Clark
• Hugh Rock Clark, DDS

• General Practice Dentistry in Yuma, AZ
• Providers in Yuma, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.