Provider Demographics
NPI:1497946982
Name:CROMER, JULIE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:CROMER
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 1:1343 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5366
Mailing Address - Country:US
Mailing Address - Phone:772-337-1111
Mailing Address - Fax:772-337-6352
Practice Address - Street 1:1343 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5366
Practice Address - Country:US
Practice Address - Phone:772-337-1111
Practice Address - Fax:772-337-6352
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist