Provider Demographics
NPI:1124674106
Name:JULIANNA P SHAMOON DMD PLLC
Entity type:Organization
Organization Name:JULIANNA P SHAMOON DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIANNNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMOON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:810-919-8123
Mailing Address - Street 1:18W070 ROYCE BLVD APT 428
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4916
Mailing Address - Country:US
Mailing Address - Phone:810-919-8123
Mailing Address - Fax:
Practice Address - Street 1:1624 W DIVISION ST STE B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3908
Practice Address - Country:US
Practice Address - Phone:773-697-9796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty