Provider Demographics
NPI:1336209337
Name:OKAMOTO, JULIE LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:LYNN
Last Name:OKAMOTO
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 1:64 OLD ORCHARD SHOPPING CENTER
Mailing Address - Street 2:SUITE 734
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1448
Mailing Address - Country:US
Mailing Address - Phone:847-675-8805
Mailing Address - Fax:
Practice Address - Street 1:64 OLD ORCHARD SHOPPING CENTER
Practice Address - Street 2:SUITE 734
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1448
Practice Address - Country:US
Practice Address - Phone:847-675-8805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist