Provider Demographics
NPI:1033465018
Name:GOURLEY, JULIA (DMD)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:
Last Name:GOURLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4072
Mailing Address - Country:US
Mailing Address - Phone:360-423-5580
Mailing Address - Fax:360-423-5596
Practice Address - Street 1:2020 9TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4072
Practice Address - Country:US
Practice Address - Phone:360-423-5580
Practice Address - Fax:360-425-5596
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602999271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice