Provider Demographics
NPI:1912392374
Name:BHARUCHA, JULIE X (DMD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:X
Last Name:BHARUCHA
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 1:2221 E BIJOU ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-8009
Mailing Address - Country:US
Mailing Address - Phone:719-576-1850
Mailing Address - Fax:719-955-3470
Practice Address - Street 1:400 SW 29TH ST.
Practice Address - Street 2:SUITE M
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-1164
Practice Address - Country:US
Practice Address - Phone:202-829-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001392122300000X
KS61473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC045313200Medicaid
KS201208880AMedicaid