Provider Demographics
NPI:1922740786
Name:ANDRADE, JULIANNE (DDS)
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:ANDRADE
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 1:5225 KALMIA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:MD
Mailing Address - Zip Code:21036-1233
Mailing Address - Country:US
Mailing Address - Phone:703-867-9957
Mailing Address - Fax:
Practice Address - Street 1:2154 GOODMAN RD W # 1
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-1303
Practice Address - Country:US
Practice Address - Phone:662-393-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0635351223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program