Provider Demographics
NPI:1558738013
Name:KONDRATYUK, JULIJA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JULIJA
Middle Name:
Last Name:KONDRATYUK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11575 N SHORE DR APT 1
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4328
Mailing Address - Country:US
Mailing Address - Phone:206-272-0159
Mailing Address - Fax:
Practice Address - Street 1:11575 N SHORE DR APT 1
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4328
Practice Address - Country:US
Practice Address - Phone:206-272-0159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414978122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist