Provider Demographics
NPI:1689116295
Name:JULIE A GUM DMD PC
Entity Type:Organization
Organization Name:JULIE A GUM DMD PC
Other - Org Name:GREEN STREET DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-746-0488
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039590122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty