Provider Demographics
NPI:1922190578
Name:BILLUPS, JULIE B (DDS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:B
Last Name:BILLUPS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4349 SAWKAW DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1768
Mailing Address - Country:US
Mailing Address - Phone:616-361-7327
Mailing Address - Fax:
Practice Address - Street 1:4349 SAWKAW DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1768
Practice Address - Country:US
Practice Address - Phone:616-361-7327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJB0150161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID16148003Medicare ID - Type Unspecified
MIU34339Medicare UPIN