Provider Demographics
NPI:1710957618
Name:FATTORE, JULIE ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
Last Name:FATTORE
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 1:39520 WOODWARD AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-5054
Mailing Address - Country:US
Mailing Address - Phone:248-430-6331
Mailing Address - Fax:248-556-2103
Practice Address - Street 1:39520 WOODWARD AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-5054
Practice Address - Country:US
Practice Address - Phone:248-430-6331
Practice Address - Fax:248-556-2103
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI18596122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist