Provider Demographics
NPI:1568874584
Name:TAE, JULEE (DDS)
Entity Type:Individual
Prefix:
First Name:JULEE
Middle Name:
Last Name:TAE
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 1:4508 BRADDOCK RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1311
Mailing Address - Country:US
Mailing Address - Phone:716-343-1193
Mailing Address - Fax:
Practice Address - Street 1:1915 S GREGG ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-5434
Practice Address - Country:US
Practice Address - Phone:432-264-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-25
Last Update Date:2014-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX298951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice