Provider Demographics
NPI:1831253491
Name:CARRARA, JULIANNE (DMD MS)
Entity type:Individual
Prefix:MS
First Name:JULIANNE
Middle Name:
Last Name:CARRARA
Suffix:
Gender:F
Credentials:DMD MS
Other - Prefix:MS
Other - First Name:JULIANNE
Other - Middle Name:
Other - Last Name:CARRARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD MS
Mailing Address - Street 1:2551 N CLARK
Mailing Address - Street 2:SUITE 701
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614
Mailing Address - Country:US
Mailing Address - Phone:773-244-1933
Mailing Address - Fax:773-244-2933
Practice Address - Street 1:2551 N CLARK ST
Practice Address - Street 2:SUITE 701
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1798
Practice Address - Country:US
Practice Address - Phone:773-244-1933
Practice Address - Fax:773-244-2933
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210018281223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics