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General NPI Number Information
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NPI Number | 1043050735
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Entity Type | Individual
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Provider Name | JULIA KISHANIE PERSAUD DDS
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Gender | Female
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 607 S 4TH ST STE B
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City | CHILLICOTHEE
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State | IL
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Zip | 61523-2277
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Country | US
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Telephone | 309-274-6237
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Fax |
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Provider Business Mailing Address
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Address Line | 31 KINGSLEY RD
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City | HUNTINGTON
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State | NY
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Zip | 11743-6428
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Country | US
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Telephone | 516-413-8873
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.035015
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License Number State | IL
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