Provider Demographics
NPI:1821142589
Name:WORTHINGTON, JULIE (DMD, MS, PA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:DMD, MS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 MADACA LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2057
Mailing Address - Country:US
Mailing Address - Phone:813-968-4040
Mailing Address - Fax:813-968-4020
Practice Address - Street 1:3640 MADACA LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2057
Practice Address - Country:US
Practice Address - Phone:813-968-4040
Practice Address - Fax:813-968-4020
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL136381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics