Healthcare Provider Details

I. General information

NPI: 1417627639
Provider Name (Legal Business Name): JULIE TOKATLIAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2021
Last Update Date: 11/12/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST FL 4
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

2151 MEETING ST APT 10103
LEXINGTON KY
40509-4657
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6193
  • Fax: 859-257-8878
Mailing address:
  • Phone: 626-428-5389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number10573
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: