Provider Demographics
NPI:1598812646
Name:WALTRIP, JULIE KRISTINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:KRISTINE
Last Name:WALTRIP
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 1:9121 GHOST MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-3667
Mailing Address - Country:US
Mailing Address - Phone:210-215-2502
Mailing Address - Fax:830-249-9021
Practice Address - Street 1:9061 W POST RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2411
Practice Address - Country:US
Practice Address - Phone:702-434-4800
Practice Address - Fax:702-433-4806
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194751223G0001X
NV70791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150886302Medicaid