Provider Demographics
NPI:1578060299
Name:WIEGAND, JULIA ROSE (DDS)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ROSE
Last Name:WIEGAND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:R
Other - Last Name:WIEGAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, PLLC
Mailing Address - Street 1:191 UNIVERSITY BLVD # 710
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4613
Mailing Address - Country:US
Mailing Address - Phone:210-273-9334
Mailing Address - Fax:
Practice Address - Street 1:2352 MEADOWS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8408
Practice Address - Country:US
Practice Address - Phone:210-273-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX342671223P0221X
TX390200000X
CODEN.002042311223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program