Provider Demographics
NPI:1457762569
Name:MITCHELL, JULIE ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:ADAMCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:175 CAMBRIDGE ST STE 310
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2796
Mailing Address - Country:US
Mailing Address - Phone:617-720-0285
Mailing Address - Fax:
Practice Address - Street 1:175 CAMBRIDGE ST STE 310
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-720-0285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011703A1223P0700X
MADN18564911223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics