Provider Demographics
NPI:1700561602
Name:JULIUS, ISAAC (DMD)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:JULIUS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 LA BONNE PKWY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7005
Mailing Address - Country:US
Mailing Address - Phone:314-629-7981
Mailing Address - Fax:
Practice Address - Street 1:1819 S HANLEY RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-2905
Practice Address - Country:US
Practice Address - Phone:314-818-3201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230237921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice