Provider Demographics
NPI:1225241201
Name:STATZ, JULIE K (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:K
Last Name:STATZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:K
Other - Last Name:MILDENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4090 WESTOWN PKWY
Mailing Address - Street 2:THE GALLERIA SUITE A-4
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-6760
Mailing Address - Country:US
Mailing Address - Phone:515-223-9700
Mailing Address - Fax:
Practice Address - Street 1:4090 WESTOWN PKWY
Practice Address - Street 2:THE GALLERIA SUITE A-4
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6760
Practice Address - Country:US
Practice Address - Phone:515-223-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA085271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics