Provider Demographics
NPI:1255882858
Name:GAMEZ, JULIE MARIE (RDH)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:GAMEZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARIE
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:155 CALLE PORTAL STE 100
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2900
Mailing Address - Country:US
Mailing Address - Phone:520-459-3011
Mailing Address - Fax:
Practice Address - Street 1:10566 N HIGHWAY 191
Practice Address - Street 2:
Practice Address - City:ELFRIDA
Practice Address - State:AZ
Practice Address - Zip Code:85610-9021
Practice Address - Country:US
Practice Address - Phone:520-642-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH04257124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist