Provider Demographics
NPI:1063070696
Name:WINTER, JULIA RIDDLE (DMD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:RIDDLE
Last Name:WINTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WATERFORD WAY
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-7251
Mailing Address - Country:US
Mailing Address - Phone:203-641-0058
Mailing Address - Fax:
Practice Address - Street 1:126 MORTON AVE
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:PA
Practice Address - Zip Code:19033-2510
Practice Address - Country:US
Practice Address - Phone:484-272-5483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS042354122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist