Provider Demographics
NPI:1225687692
Name:AVRUTIK, JULIANNE FANNY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIANNE
Middle Name:FANNY
Last Name:AVRUTIK
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 1:22 ELEANOR DR
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1816
Mailing Address - Country:US
Mailing Address - Phone:908-812-5633
Mailing Address - Fax:
Practice Address - Street 1:395 RIDGE RD STE 5
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1398
Practice Address - Country:US
Practice Address - Phone:732-274-2544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027331001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice