Provider Demographics
NPI:1194567339
Name:MACHGAN, JULIA KRISTINE (DMD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:KRISTINE
Last Name:MACHGAN
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 1:3721 W FOLSOM ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-3811
Mailing Address - Country:US
Mailing Address - Phone:715-559-4207
Mailing Address - Fax:
Practice Address - Street 1:405 W PRAIRIE VIEW RD
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-3389
Practice Address - Country:US
Practice Address - Phone:715-723-7175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001530151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice