Provider Demographics
NPI:1356662969
Name:EDGERTON, JULIA MARLYS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:MARLYS
Last Name:EDGERTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JULIA
Other - Middle Name:MARLYS
Other - Last Name:LERCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:216 TRAFFIC WAY
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3335
Mailing Address - Country:US
Mailing Address - Phone:805-489-3419
Mailing Address - Fax:805-489-3944
Practice Address - Street 1:216 TRAFFIC WAY
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3335
Practice Address - Country:US
Practice Address - Phone:805-489-3419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA593761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice