Provider Demographics
NPI:1972587517
Name:FORD, JULIENNE ROSE (DMD)
Entity Type:Individual
Prefix:
First Name:JULIENNE
Middle Name:ROSE
Last Name:FORD
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 1:3000 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:BRADDOCK HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15221
Mailing Address - Country:US
Mailing Address - Phone:412-824-7511
Mailing Address - Fax:412-824-6265
Practice Address - Street 1:3000 LOCUST ST
Practice Address - Street 2:
Practice Address - City:BRADDOCK HILLS
Practice Address - State:PA
Practice Address - Zip Code:15221
Practice Address - Country:US
Practice Address - Phone:412-824-7511
Practice Address - Fax:412-824-6265
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025179L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF0427795OtherBS BS UNITED CONCORDIA
0008198OtherDORAL UPMC BEST
068391OtherTHREE RIVERS HEALTH PLAN
PA0010512380001OtherMEDICAL ASSISTANCE
5040169OtherAETNA
242531OtherDENTAL BENEFIT PROVIDERS