=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801295910
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE S. NUNU DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2014
-----------------------------------------------------
Last Update Date | 06/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27115 GRATIOT AVE
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48066-2900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-771-5880
-----------------------------------------------------
Fax | 586-771-5882
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27115 GRATIOT AVE
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48066-2900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-771-5880
-----------------------------------------------------
Fax | 586-771-5882
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 2901021350
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------