Provider Demographics
NPI:1154008381
Name:SNELL, JULIA LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:LYNN
Last Name:SNELL
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 1:11501 N PORT WASHINGTON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3466
Mailing Address - Country:US
Mailing Address - Phone:262-241-8880
Mailing Address - Fax:262-241-5250
Practice Address - Street 1:11501 N PORT WASHINGTON RD STE 102
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3466
Practice Address - Country:US
Practice Address - Phone:262-241-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001246-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist