Provider Demographics
NPI:1144241654
Name:DANIELS, JULIE S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:S
Last Name:DANIELS
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 1:201 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-1759
Mailing Address - Country:US
Mailing Address - Phone:563-285-8662
Mailing Address - Fax:563-285-1337
Practice Address - Street 1:201 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748-1759
Practice Address - Country:US
Practice Address - Phone:563-285-8662
Practice Address - Fax:563-285-1337
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA063569OtherUNITED CONCORDIA
IA0056093Medicaid
IA27333OtherWELLMARK BC/BS