Provider Demographics
NPI:1053972083
Name:WILSON, JULIA MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:MARIE
Other - Last Name:ARIOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:HYANNIS PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02647
Mailing Address - Country:US
Mailing Address - Phone:774-265-5475
Mailing Address - Fax:
Practice Address - Street 1:2187 MAIN ST
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-1817
Practice Address - Country:US
Practice Address - Phone:508-896-5951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18583561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice