Provider Demographics
NPI:1053456491
Name:CHILDERS, JULIE OLSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:OLSON
Last Name:CHILDERS
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 1:700 PLAZA CIR
Mailing Address - Street 2:SUITE M
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-7556
Mailing Address - Country:US
Mailing Address - Phone:864-833-5673
Mailing Address - Fax:864-833-0484
Practice Address - Street 1:700 PLAZA CIR
Practice Address - Street 2:SUITE M
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7556
Practice Address - Country:US
Practice Address - Phone:864-833-5673
Practice Address - Fax:864-833-0484
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice