Provider Demographics
NPI:1114267762
Name:ANDERSON, JULIE A (DMD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:ANDERSON
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 1:59 DG AF POSTGRADUATE DENTAL SCHOOL
Mailing Address - Street 2:2133 PEPPERRELL STREET, BUILDING 3352
Mailing Address - City:JBSA-LACKLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78236-5313
Mailing Address - Country:US
Mailing Address - Phone:210-292-6258
Mailing Address - Fax:210-292-2618
Practice Address - Street 1:59 DG AF POSTGRADUATE DENTAL SCHOOL
Practice Address - Street 2:2133 PEPPERRELL STREET, BUILDING 3352
Practice Address - City:JBSA-LACKLAND
Practice Address - State:TX
Practice Address - Zip Code:78236-5313
Practice Address - Country:US
Practice Address - Phone:210-292-6258
Practice Address - Fax:210-292-2618
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY93311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice