Provider Demographics
NPI:1932458676
Name:COVINO, JULIE MARIE (DMD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:COVINO
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 1:2408 VICTORY PARK LANE
Mailing Address - Street 2:APT 1032
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219
Mailing Address - Country:US
Mailing Address - Phone:203-996-1146
Mailing Address - Fax:
Practice Address - Street 1:2408 VICTORY PARK LANE
Practice Address - Street 2:APT 1032
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219
Practice Address - Country:US
Practice Address - Phone:203-996-1146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist