Provider Demographics
NPI:1730231408
Name:JULIAN, JON MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:MICHAEL
Last Name:JULIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BOTANICAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690
Mailing Address - Country:US
Mailing Address - Phone:864-836-3611
Mailing Address - Fax:888-778-6022
Practice Address - Street 1:125 BOTANICAL CIRCLE
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690
Practice Address - Country:US
Practice Address - Phone:864-836-3611
Practice Address - Fax:888-778-6022
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54471223E0200X
SC69841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223E0200XDental ProvidersDentistEndodontics