Provider Demographics
NPI:1811406275
Name:MINGAY, JULIE R
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:R
Last Name:MINGAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 COUNTY ROAD 545
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9215
Mailing Address - Country:US
Mailing Address - Phone:906-360-2148
Mailing Address - Fax:
Practice Address - Street 1:301 EXPLORER ST
Practice Address - Street 2:
Practice Address - City:GWINN
Practice Address - State:MI
Practice Address - Zip Code:49841-2813
Practice Address - Country:US
Practice Address - Phone:906-346-9275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902006483124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist