Provider Demographics
NPI:1871267385
Name:WATERS, JUSTIN JAMES (DMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:JAMES
Last Name:WATERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7340 E LEGACY BLVD UNIT E3007
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6396
Mailing Address - Country:US
Mailing Address - Phone:480-466-6399
Mailing Address - Fax:
Practice Address - Street 1:8390 E VIA DE VENTURA STE F200
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3177
Practice Address - Country:US
Practice Address - Phone:480-400-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-07
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0110961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice