Jacob D Justice, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401416829 Issued in VA

Practice address

807 Park Ave NE
Norton, VA 24273-1009

Phone

(276) 679-6030

Fax

(276) 325-0459

NPI assigned

Sep 20, 2017

Last updated

Jan 6, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clisso Dentistry PC

  • Dentist
  • Norton, VA
  • NPI 1336275973
  NPD (past)
• Elkhorn Dental

  • Dental Clinic/Center
  • Elkhorn City, KY
  • NPI 1699046011
  NPD (past)
• Elkhorn Dental PSC

  • Dental Clinic/Center
  • Elkhorn City, KY
  • NPI 1467010629
  NPD (past)

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

{
    "created_epoch": "1505865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609891200000",
    "number": "1588173728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1500",
            "city": "ELKHORN CITY",
            "state": "KY",
            "postal_code": "41522",
            "telephone_number": "606-754-0155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 PARK AVE NE",
            "city": "NORTON",
            "state": "VA",
            "postal_code": "242731009",
            "telephone_number": "276-679-6030",
            "fax_number": "276-325-0459"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "155 East Main Street",
            "address_purpose": "LOCATION",
            "city": "Elkhorn City",
            "state": "KY",
            "postal_code": "41522",
            "country_code": "US",
            "telephone_number": "606-754-0155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JUSTICE",
        "first_name": "JACOB",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-20",
        "last_updated": "2021-01-06",
        "certification_date": "2020-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "10032",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401416829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Bram Johns, M.D.
• Megan Brittany Johnson, D.O.
• Tonya Lynne Johnson, MD
• Robert Ben Jolley Jr., MD
• Anilkumar Raghunath Joshi, MD
• Sanchita Suresh Kanakannavar, MD
• Jaimin Maheshbhai Kapadia, DO
• Gurvinder Kaur, MD
• Ted Martin Kelly, MD
• Jeffrey McKinley Kennedy, LPC

• General Practice Dentistry in Norton, VA
• Providers in Norton, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.