Provider Demographics
NPI:1376838367
Name:SKINNER, JULIA SPRANG (DMD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:SPRANG
Last Name:SKINNER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 TRADEWINDS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-4183
Mailing Address - Country:US
Mailing Address - Phone:404-457-5116
Mailing Address - Fax:
Practice Address - Street 1:4635 GULFSTARR DR
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-5780
Practice Address - Country:US
Practice Address - Phone:850-654-8665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 193331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice