Provider Demographics
NPI:1639138514
Name:HOTZ - SUDEKUM, JULIA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:MARIE
Last Name:HOTZ - SUDEKUM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JULIA
Other - Middle Name:MARIE
Other - Last Name:HOTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:11810 GRAVIOS RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-0570
Mailing Address - Country:US
Mailing Address - Phone:314-842-5000
Mailing Address - Fax:314-842-7199
Practice Address - Street 1:11810 GRAVIOS RD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-0570
Practice Address - Country:US
Practice Address - Phone:314-842-5000
Practice Address - Fax:314-842-7199
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010072761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice