Individual
MRS. JULIE A VAVRUSKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1389 S US HIGHWAY 301, SUMTERVILLE, FL 33585-5135
(352) 793-5900
(352) 793-6269
Mailing address
1425 S US HIGHWAY 301, SUMTERVILLE, FL 33585-5135
(352) 793-5900
(352) 793-6269
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN15250
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
029547700
MEDICAID FQHC
FL
01
—
029547796
MEDICAID DENTAL
FL
01
—
057724300
MEDICAID FEE FOR SERVICE
FL
05
—
680013100
—
LA
Enumeration date
08/29/2005
Last updated
08/09/2007
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