Provider Demographics
NPI:1841782737
Name:ABLES, JULIE ALYSSA WOLFE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ALYSSA WOLFE
Last Name:ABLES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 HAWKS CRST
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-6139
Mailing Address - Country:US
Mailing Address - Phone:601-441-6351
Mailing Address - Fax:
Practice Address - Street 1:110 HIGHWAY 12 W STE A
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3760
Practice Address - Country:US
Practice Address - Phone:662-338-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3989181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06951091Medicaid