Provider Demographics
NPI:1073356481
Name:RUSS, JULIA I (DDS)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:I
Last Name:RUSS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 OLD TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-3341
Mailing Address - Country:US
Mailing Address - Phone:954-556-0335
Mailing Address - Fax:
Practice Address - Street 1:75 LEE HWY
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:VA
Practice Address - Zip Code:24482-2505
Practice Address - Country:US
Practice Address - Phone:540-822-0344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014189721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice