MEDICARE: DR. JULIE ANN FATTORE 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	122300000X	Dentist	18596	MI

General Provider Information

NPI Number	:	1710957618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE ANN FATTORE DDS

Provider Business Mailing Address
First Line	:	39520 WOODWARD AVE
Second Line	:	SUITE 105
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-5054
Country	:	US
Telephone Number	:	248-430-6331
Fax Number	:	248-556-2103

Provider Business Practice Location Address
First Line	:	39520 WOODWARD AVE
Second Line	:	SUITE 105
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-5054
Country	:	US
Telephone Number	:	248-430-6331
Fax Number	:	248-556-2103

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	03/05/2015

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