Provider Demographics
NPI:1437776531
Name:DAVIS, JULIE (DMD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:DAVIS
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 1:170 RUSTY GANS DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32408-4510
Mailing Address - Country:US
Mailing Address - Phone:850-890-2653
Mailing Address - Fax:
Practice Address - Street 1:1308 W NINE MILE RD STE 9
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-1761
Practice Address - Country:US
Practice Address - Phone:850-484-4844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice