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General NPI Number Information
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NPI Number | 1689116295
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Entity Type | Organization
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Legal Business Name | JULIE A GUM DMD PC
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Dates
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Enumeration Date | 11/14/2016
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Last Update Date | 11/14/2016
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Provider Practice Location Address
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Address Line | 150 S GREEN ST
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City | NAZARETH
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State | PA
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Zip | 18064-2011
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Country | US
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Telephone | 610-746-0488
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Fax |
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Provider Business Mailing Address
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Address Line | 150 S GREEN ST
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City | NAZARETH
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State | PA
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Zip | 18064-2011
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Country | US
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Telephone | 610-746-0488
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JULIE A GUM
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Credential | D.M.D.
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Telephone | 610-746-0488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS039590
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License Number State | PA
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