Provider Demographics
NPI:1275730798
Name:PRUNESKI, JULIE ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANNE
Last Name:PRUNESKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:ANNE
Other - Last Name:CORBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:690 COOPER FOSTER PARK RD
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053
Mailing Address - Country:US
Mailing Address - Phone:440-282-2023
Mailing Address - Fax:440-233-5401
Practice Address - Street 1:690 COOPER FOSTER PARK RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053
Practice Address - Country:US
Practice Address - Phone:440-282-2023
Practice Address - Fax:440-233-5401
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2631174400000X
OH30.0226741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No174400000XOther Service ProvidersSpecialist