Provider Demographics
NPI:1457790784
Name:KOO, JULIA (DDS)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:KOO
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 1:220 E COLUMBIA AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1902
Mailing Address - Country:US
Mailing Address - Phone:201-988-9833
Mailing Address - Fax:
Practice Address - Street 1:29 EMMONS DR STE C80
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5983
Practice Address - Country:US
Practice Address - Phone:609-514-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2018-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ025545001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics