Healthcare Provider Details

I. General information

NPI: 1821142589
Provider Name (Legal Business Name): JULIE WORTHINGTON DMD, MS, PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 MADACA LN
TAMPA FL
33618-2057
US

IV. Provider business mailing address

3640 MADACA LN
TAMPA FL
33618-2057
US

V. Phone/Fax

Practice location:
  • Phone: 813-968-4040
  • Fax: 813-968-4020
Mailing address:
  • Phone: 813-968-4040
  • Fax: 813-968-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number13638
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: