Provider Demographics
NPI:1831544329
Name:DOBSON, JULIA BROADDUS (DMD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:BROADDUS
Last Name:DOBSON
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 1:2813 N HURSTBOURNE PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-1281
Mailing Address - Country:US
Mailing Address - Phone:502-640-0920
Mailing Address - Fax:
Practice Address - Street 1:2813 N HURSTBOURNE PKWY STE 106
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-1281
Practice Address - Country:US
Practice Address - Phone:502-640-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9762122300000X, 1223P0221X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7101060300Medicaid