Provider Demographics
NPI:1033361738
Name:HAVERI, JULIE ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
Last Name:HAVERI
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 1:121 RUTGERS AVE
Mailing Address - Street 2:
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081-1713
Mailing Address - Country:US
Mailing Address - Phone:610-543-3114
Mailing Address - Fax:
Practice Address - Street 1:121 RUTGERS AVE
Practice Address - Street 2:
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-1713
Practice Address - Country:US
Practice Address - Phone:610-543-3114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028879L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice