Basic Information
| Provider Information | |||||||||
| NPI: | 1619486826 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JULIANA | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PHDHP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| OtherMiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N HANOVER ST | ||||||||
| Address2: | |||||||||
| City: | CARLISLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170132421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172186670 | ||||||||
| FaxNumber: | 7172186671 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 N HANOVER ST | ||||||||
| Address2: | |||||||||
| City: | CARLISLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170132421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172186670 | ||||||||
| FaxNumber: | 7172186671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | PHDH000510 | PA | Y | Dental Providers | Dental Hygienist |
No ID Information.