Healthcare Provider Details

I. General information

NPI: 1427033422
Provider Name (Legal Business Name): JULIE R CALLUM DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 BROAD ST # R
LYNN MA
01902-5020
US

IV. Provider business mailing address

81R BROAD ST
LYNN MA
01902-5003
US

V. Phone/Fax

Practice location:
  • Phone: 781-593-7665
  • Fax: 781-593-8344
Mailing address:
  • Phone: 781-593-7665
  • Fax: 781-593-8344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number18299
License Number StateMA

VIII. Authorized Official

Name: DR. JULIE ROSE CALLUM
Title or Position: OWNER/OPERATOR
Credential: DMD
Phone: 781-593-7665