Provider Demographics
NPI:1790276442
Name:DAWSON, JULIA JENKINS (DMD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:JENKINS
Last Name:DAWSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:SUZANNE
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1000 ARDMORE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-2304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2052 HARRIS PIKE # 54
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-7783
Practice Address - Country:US
Practice Address - Phone:859-898-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice