Provider Demographics
NPI:1023577061
Name:ESLAVA, JULIANA
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:
Last Name:ESLAVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 JUNIPER ST NE UNIT CU-4
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1364
Mailing Address - Country:US
Mailing Address - Phone:770-628-2444
Mailing Address - Fax:770-599-2564
Practice Address - Street 1:855 JUNIPER ST NE UNIT CU-4
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1364
Practice Address - Country:US
Practice Address - Phone:770-628-2444
Practice Address - Fax:770-599-2564
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0159681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice