Provider Demographics
NPI:1558555490
Name:CALLUM, JULIE R (DMD,PC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:R
Last Name:CALLUM
Suffix:
Gender:F
Credentials:DMD,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 BROAD ST # R
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-5020
Mailing Address - Country:US
Mailing Address - Phone:781-593-7665
Mailing Address - Fax:
Practice Address - Street 1:81 BROAD ST # R
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-5020
Practice Address - Country:US
Practice Address - Phone:781-593-7665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA182991223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA18299OtherDELTA DENTAL
MAX10992OtherBLUE CROSS/BLUE SHIELD