Provider Demographics
NPI:1760400659
Name:CORREAL, JULIA E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:E
Last Name:CORREAL
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 1:1188 STONECREST BLVD
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6632
Mailing Address - Country:US
Mailing Address - Phone:888-764-5314
Mailing Address - Fax:888-764-5314
Practice Address - Street 1:1188 STONECREST BLVD STE 104
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-6633
Practice Address - Country:US
Practice Address - Phone:888-764-5314
Practice Address - Fax:888-764-5314
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048104122300000X
SC88251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1174112387OtherNPI 2