Provider Demographics
NPI:1457849044
Name:PERSON, JULIE LEE (PHDHP)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:LEE
Last Name:PERSON
Suffix:
Gender:F
Credentials:PHDHP
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:LEE
Other - Last Name:PERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:630 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-2430
Mailing Address - Country:US
Mailing Address - Phone:570-326-7130
Mailing Address - Fax:
Practice Address - Street 1:630 HARDING AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-2430
Practice Address - Country:US
Practice Address - Phone:570-326-7130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-29
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPHDH000562124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist