Active NPI
Ethan Just, DMD
- Orthodontics and Dentofacial Orthopedics Dentistry
- Manitowoc, WI
National Provider Identifier
1467225367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 6001067-15
- Practice address
- 340 E Reed Ave
Manitowoc, WI 54220-2123 - Phone
- (920) 214-9828
- NPI assigned
- Nov 1, 2023
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 6001067-15 | WI | Primary |
Addresses
Primary practice location
340 E Reed Ave
Manitowoc, WI 54220-2123
Mailing address
1732 Blue Heron Rd
Manitowoc, WI 54220-9445
Phone (920) 629-1096
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 |
|---|---|---|---|
| 6001067-15 | WI | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1744761600000",
"number": "1467225367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1732 BLUE HERON RD",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542209445",
"telephone_number": "920-629-1096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "340 E REED AVE",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542202123",
"telephone_number": "920-214-9828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUST",
"first_name": "ETHAN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-11-01",
"last_updated": "2025-04-16",
"certification_date": "2025-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "WI",
"license": "6001067-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manitowoc, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.