Provider Demographics
NPI:1326053109
Name:MARTINSON, JULIE MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:MARTINSON
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 1:2050 M 119
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8962
Mailing Address - Country:US
Mailing Address - Phone:231-347-7471
Mailing Address - Fax:231-347-7836
Practice Address - Street 1:2050 M 119
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8962
Practice Address - Country:US
Practice Address - Phone:231-347-7471
Practice Address - Fax:231-347-7836
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0137801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID811511OtherBLUECROSS BLUESHIELD