Provider Demographics
NPI:1548319304
Name:DEWEY, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:DEWEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 LANCASTER DR NE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2676
Mailing Address - Country:US
Mailing Address - Phone:503-362-8359
Mailing Address - Fax:
Practice Address - Street 1:831 LANCASTER DR NE
Practice Address - Street 2:SUITE 2
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2676
Practice Address - Country:US
Practice Address - Phone:503-362-8359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD86981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice