Provider Demographics
NPI:1851309124
Name:VIGNEAULT, JULIE (DMD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:VIGNEAULT
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 1:402 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3823
Mailing Address - Country:US
Mailing Address - Phone:617-666-4444
Mailing Address - Fax:617-666-1113
Practice Address - Street 1:402 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-3823
Practice Address - Country:US
Practice Address - Phone:617-666-4444
Practice Address - Fax:617-666-1113
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice