Provider Demographics
NPI:1558940841
Name:STEPHANIE JULIAN DDS PC
Entity Type:Organization
Organization Name:STEPHANIE JULIAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:TRICIA
Authorized Official - Last Name:JULIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-546-6709
Mailing Address - Street 1:35A GUY LOMBARDO AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3604
Mailing Address - Country:US
Mailing Address - Phone:516-546-6709
Mailing Address - Fax:516-546-0189
Practice Address - Street 1:35A GUY LOMBARDO AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3604
Practice Address - Country:US
Practice Address - Phone:516-546-6709
Practice Address - Fax:516-546-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty