Provider Demographics
NPI:1588003412
Name:GUM, JULIE ALICIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ALICIA
Last Name:GUM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2011
Mailing Address - Country:US
Mailing Address - Phone:610-746-0488
Mailing Address - Fax:610-746-9088
Practice Address - Street 1:150 S GREEN ST
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-2011
Practice Address - Country:US
Practice Address - Phone:610-746-0488
Practice Address - Fax:610-746-9088
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039590122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist