Provider Demographics
NPI:1356969315
Name:ESCOBAR, JULIA KATHLEEN (DDS)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:KATHLEEN
Last Name:ESCOBAR
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 1:5001 N MESA ST APT 1304
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5930
Mailing Address - Country:US
Mailing Address - Phone:720-841-4466
Mailing Address - Fax:
Practice Address - Street 1:MADIGAN ANNEX SECOND FLOOR BLDG 9900
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-5930
Practice Address - Country:US
Practice Address - Phone:323-918-9868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61291666122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist