Provider Demographics
NPI:1124056841
Name:HALLISY, JULIA ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:ANN
Last Name:HALLISY
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 1:345 WEST PORTAL AVE
Mailing Address - Street 2:# 210
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127
Mailing Address - Country:US
Mailing Address - Phone:415-681-1011
Mailing Address - Fax:415-681-1022
Practice Address - Street 1:345 WEST PORTAL AVE
Practice Address - Street 2:# 210
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127
Practice Address - Country:US
Practice Address - Phone:415-681-1011
Practice Address - Fax:415-681-1022
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36659122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist