Provider Demographics
NPI:1487263653
Name:LACY, JULIA ANN (DMD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ANN
Last Name:LACY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:ANN
Other - Last Name:SHELBOURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6824 TERRA RYE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2757
Mailing Address - Country:US
Mailing Address - Phone:262-215-8072
Mailing Address - Fax:
Practice Address - Street 1:8210 FLOYD CURL DR # 8122
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3923
Practice Address - Country:US
Practice Address - Phone:210-450-3715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXETN7841223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics