Provider Demographics
NPI:1447397633
Name:KAVANAUGH, JULIE G (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:G
Last Name:KAVANAUGH
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 1:1829 56TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3024
Mailing Address - Country:US
Mailing Address - Phone:970-351-0400
Mailing Address - Fax:
Practice Address - Street 1:1829 56TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3024
Practice Address - Country:US
Practice Address - Phone:970-351-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice