MEDICARE: DR. JULIE KRISTINE WALTRIP DDS

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	1223G0001X	General Practice Dentistry	19475	TX
2	1223G0001X	General Practice Dentistry	7079	NV

General Provider Information

NPI Number	:	1598812646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE KRISTINE WALTRIP DDS

Provider Business Mailing Address
First Line	:	9121 GHOST MOUNTAIN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-3667
Country	:	US
Telephone Number	:	210-215-2502
Fax Number	:	830-249-9021

Provider Business Practice Location Address
First Line	:	9061 W POST RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2411
Country	:	US
Telephone Number	:	702-434-4800
Fax Number	:	702-433-4806

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	03/01/2021

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