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NPI Code Detail

MEDICARE: DR. JULIA E CORREAL DDS

MEDICARE: DR. JULIA E CORREAL 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
1122300000XDentist048104NY
21223G0001XGeneral Practice Dentistry8825SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11174112387OTHERSCNPI 2

General Provider Information

NPI Number : 1760400659
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JULIA E CORREAL DDS
Provider Business Mailing Address
First Line : 1188 STONECREST BLVD
Second Line :
City : TEGA CAY
State : SC
Zip : 29708-6632
Country : US
Telephone Number : 888-764-5314
Fax Number : 888-764-5314
Provider Business Practice Location Address
First Line : 1188 STONECREST BLVD STE 104
Second Line :
City : TEGA CAY
State : SC
Zip : 29708-6633
Country : US
Telephone Number : 888-764-5314
Fax Number : 888-764-5314
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 02/25/2021

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