Provider Demographics
NPI:1720292345
Name:MELBINGER-WAGNER, JULIE ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANNE
Last Name:MELBINGER-WAGNER
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 1:10345 N PORT WASHINGTON RD STE 150
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5746
Mailing Address - Country:US
Mailing Address - Phone:262-240-9400
Mailing Address - Fax:262-236-9874
Practice Address - Street 1:10345 N PORT WASHINGTON RD STE 150
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5746
Practice Address - Country:US
Practice Address - Phone:262-240-9400
Practice Address - Fax:262-236-9874
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190263961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice