Provider Demographics
NPI:1700910007
Name:FAIGEL, JULIA O (DMD)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:O
Last Name:FAIGEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 ADAMS ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-4914
Mailing Address - Country:US
Mailing Address - Phone:617-823-2111
Mailing Address - Fax:
Practice Address - Street 1:480 ADAMS ST
Practice Address - Street 2:SUITE 112
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-4914
Practice Address - Country:US
Practice Address - Phone:617-823-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204851223G0001X
NH037231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0203980Medicaid