Provider Demographics
NPI:1902245855
Name:MAGNUS, JULIE LYNNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:LYNNE
Last Name:MAGNUS
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 1:7440 N SHADELAND AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2027
Mailing Address - Country:US
Mailing Address - Phone:317-849-9961
Mailing Address - Fax:
Practice Address - Street 1:7440 N SHADELAND AVE STE 212
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2027
Practice Address - Country:US
Practice Address - Phone:317-849-9961
Practice Address - Fax:317-288-5746
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011950A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice