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General NPI Number Information
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NPI Number | 1427033422
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Entity Type | Organization
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Legal Business Name | JULIE R CALLUM DMD PC
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 81 BROAD ST # R
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City | LYNN
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State | MA
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Zip | 01902-5020
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Country | US
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Telephone | 781-593-7665
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Fax | 781-593-8344
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Provider Business Mailing Address
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Address Line | 81R BROAD ST
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City | LYNN
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State | MA
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Zip | 01902-5003
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Country | US
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Telephone | 781-593-7665
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Fax | 781-593-8344
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. JULIE ROSE CALLUM
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Credential | DMD
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Telephone | 781-593-7665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 18299
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License Number State | MA
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