Provider Demographics
NPI:1154587251
Name:BURCHETT, JULIA (JULIA BURCHETT)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:
Last Name:BURCHETT
Suffix:
Gender:F
Credentials:JULIA BURCHETT
Other - Prefix:DR
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:BURCHETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JULIA BURCHETT
Mailing Address - Street 1:6300 GEORGETOWN BLVD
Mailing Address - Street 2:ST 135
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784
Mailing Address - Country:US
Mailing Address - Phone:410-795-0055
Mailing Address - Fax:
Practice Address - Street 1:10203 TANAGER LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3943
Practice Address - Country:US
Practice Address - Phone:410-730-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD141981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice