Provider Demographics
NPI:1932462926
Name:JULIE M. LONGORIA DDS, MSD, PA
Entity Type:Organization
Organization Name:JULIE M. LONGORIA DDS, MSD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGORIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-441-0399
Mailing Address - Street 1:4309 OLEANDER ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-5226
Mailing Address - Country:US
Mailing Address - Phone:806-441-0399
Mailing Address - Fax:
Practice Address - Street 1:5311 KIRBY DR
Practice Address - Street 2:211
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1364
Practice Address - Country:US
Practice Address - Phone:806-441-0399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-24
Last Update Date:2012-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23928122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty