| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JUSTIN MACKERT | 1528685369 | 2020-06-27 |
Justin Mackert is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1528685369. Registration indicates Justin Mackert is a provider of access to dentists-general services with a specialization in Dental Providers, Dentist (Dental Providers, Dentist) (Dentist: General Practice, ) (Dental, ) (Dentist General Practice, Dental Providers) (Dentist, )
| Registration | PART-B:Y DME:Y HHA:Y PMD:N |
| Entity Type | Individual |
| Provider Name | Justin Mackert DMD |
| Practice Office Address | 15711 MADISON AVE STE 104 LAKEWOOD, OH US |
| Practice Office Telephone | 4408233175 |
| Practice Office Fax | 2162287951 |
| Mailing Address | 15711 MADISON AVE STE 104 LAKEWOOD, OH 441075655 US |
| Business Telephone | 4408233175 |
| [email protected] [] | [email protected] | Direct |
| Code | Practice | License No State |
|---|---|---|
| 1223G0001X PRIMARY | Access to Dentists-General Dental Providers Dentist Dental Providers Dentist Dentist: General Practice Dental Dentist General Practice Dental Providers Dentist | 30.026215
OH |
| 30.026215 | OTHER | OH | DENTAL LICENSE |