Provider Demographics
NPI:1578117651
Name:PIKUS, JULIANNA MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:JULIANNA
Middle Name:MARIE
Last Name:PIKUS
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 1:955 WESTLAKE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-1105
Mailing Address - Country:US
Mailing Address - Phone:812-375-4258
Mailing Address - Fax:
Practice Address - Street 1:851 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4401
Practice Address - Country:US
Practice Address - Phone:773-929-1150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-28
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0322941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice