Provider Demographics
NPI:1568848356
Name:DAVIS, JULIE K (DDS)
Entity Type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:K
Last Name:DAVIS
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 1:20 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4054
Mailing Address - Country:US
Mailing Address - Phone:847-698-2161
Mailing Address - Fax:847-698-1004
Practice Address - Street 1:20 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4054
Practice Address - Country:US
Practice Address - Phone:847-698-2161
Practice Address - Fax:847-698-1004
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190297781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice