Healthcare Provider Details

I. General information

NPI: 1215141759
Provider Name (Legal Business Name): JULIE ANN VIGNES DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 E 8TH ST
PORT ANGELES WA
98362-6224
US

IV. Provider business mailing address

606 E 8TH ST
PORT ANGELES WA
98362-6224
US

V. Phone/Fax

Practice location:
  • Phone: 360-457-3127
  • Fax: 360-452-7060
Mailing address:
  • Phone: 360-457-3127
  • Fax: 360-452-7060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4666
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: