Provider Demographics
NPI:1366703985
Name:JULIA H JOH, DMD PA
Entity type:Organization
Organization Name:JULIA H JOH, DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-781-6780
Mailing Address - Street 1:4301 N FEDERAL HWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-6519
Mailing Address - Country:US
Mailing Address - Phone:954-781-6780
Mailing Address - Fax:954-781-6781
Practice Address - Street 1:4301 N FEDERAL HWY
Practice Address - Street 2:SUITE 5
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6519
Practice Address - Country:US
Practice Address - Phone:954-781-6780
Practice Address - Fax:954-781-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18734261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental