Provider Demographics
NPI:1417950171
Name:IGDALEV, JULIA (DDS)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:IGDALEV
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 1:1625 ANDERSON AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2748
Mailing Address - Country:US
Mailing Address - Phone:201-224-9444
Mailing Address - Fax:201-224-9422
Practice Address - Street 1:1625 ANDERSON AVE
Practice Address - Street 2:STE 202
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2748
Practice Address - Country:US
Practice Address - Phone:201-224-9444
Practice Address - Fax:201-224-9422
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI20134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist