=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396718623
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULI S WEMMER D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2006
-----------------------------------------------------
Last Update Date | 03/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 CHERRY ST SE
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49503-4658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-458-8593
-----------------------------------------------------
Fax | 616-458-0738
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2965 E FULTON ST
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49506-1811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-954-2279
-----------------------------------------------------
Fax | 616-458-0738
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2901011979
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------