Individual
DR. JULENE FUNK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
12014042A
IN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DDS104577
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12014042A
INDIANA DENTAL LICENSURE
IN
05
—
300075895
—
IN
01
—
DDS104577
CALIFORNIA DENTAL BOARD LICENSURE
CA
Enumeration date
12/30/2019
Last updated
07/27/2023
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