Provider Demographics
NPI:1649568296
Name:GRAF DOMEYER, JULIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:GRAF DOMEYER
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 1:238 FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:CASHTON
Mailing Address - State:WI
Mailing Address - Zip Code:54619-2002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:238 FRONT ST
Practice Address - Street 2:
Practice Address - City:CASHTON
Practice Address - State:WI
Practice Address - Zip Code:54619-2002
Practice Address - Country:US
Practice Address - Phone:608-654-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6730-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice