Provider Demographics
NPI:1003980491
Name:FORSTADT, JULIE NEAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:NEAL
Last Name:FORSTADT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 CARRELL LN
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-1007
Mailing Address - Country:US
Mailing Address - Phone:707-224-4752
Mailing Address - Fax:
Practice Address - Street 1:763 BROADWAY
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-7010
Practice Address - Country:US
Practice Address - Phone:707-938-8528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA375491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice