Provider Demographics
NPI:1073193819
Name:LECAVALIER, JULIA (DMD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:LECAVALIER
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 1:1075 S KIMBLES RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-2635
Mailing Address - Country:US
Mailing Address - Phone:215-595-3965
Mailing Address - Fax:
Practice Address - Street 1:1075 BERKSHIRE BLVD STE 950
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1264
Practice Address - Country:US
Practice Address - Phone:215-595-3965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043047122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist