MEDICARE: DR. JULIE LYNNE MAGNUS D.D.S

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	12011950A	IN

General Provider Information

NPI Number	:	1902245855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE LYNNE MAGNUS D.D.S

Provider Business Mailing Address
First Line	:	7440 N SHADELAND AVE STE 212
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2027
Country	:	US
Telephone Number	:	317-849-9961
Fax Number	:

Provider Business Practice Location Address
First Line	:	7440 N SHADELAND AVE STE 212
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2027
Country	:	US
Telephone Number	:	317-849-9961
Fax Number	:	317-288-5746

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

Provider Enumeration Date	:	06/24/2013
Last Update Date	:	02/05/2024

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