Provider Demographics
NPI:1255643532
Name:DRAKE-TOBIASEN, JULIA ANNE (RDH)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ANNE
Last Name:DRAKE-TOBIASEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28389 N ISLAND CIR
Mailing Address - Street 2:
Mailing Address - City:HOLLANDALE
Mailing Address - State:MN
Mailing Address - Zip Code:56045-4400
Mailing Address - Country:US
Mailing Address - Phone:507-889-3144
Mailing Address - Fax:
Practice Address - Street 1:28389 N ISLAND CIR
Practice Address - Street 2:
Practice Address - City:HOLLANDALE
Practice Address - State:MN
Practice Address - Zip Code:56045-4400
Practice Address - Country:US
Practice Address - Phone:507-889-3144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH8254124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist