MEDICARE: JULIA DURHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	0401414244	VA

General Provider Information

NPI Number	:	1518321009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA DURHAM

Provider Business Mailing Address
First Line	:	1206 WILLOW LAWN DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-1409
Country	:	US
Telephone Number	:	804-282-6436
Fax Number	:

Provider Business Practice Location Address
First Line	:	1206 WILLOW LAWN DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-1409
Country	:	US
Telephone Number	:	804-282-6436
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2016
Last Update Date	:	04/11/2016

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Directions to “ JULIA DURHAM ” Practice Location

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