Provider Demographics
NPI:1841503000
Name:BOERGER, JULIE (DMD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:BOERGER
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 1:65 MACON AVE
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2409
Mailing Address - Country:US
Mailing Address - Phone:631-379-8863
Mailing Address - Fax:631-218-1734
Practice Address - Street 1:228 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2711
Practice Address - Country:US
Practice Address - Phone:631-581-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist