Provider Demographics
NPI:1043466378
Name:CHINCHILLA, JULIO E (DDS)
Entity type:Individual
Prefix:DR
First Name:JULIO
Middle Name:E
Last Name:CHINCHILLA
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 1:195 14TH ST NE UNIT 2401
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2678
Mailing Address - Country:US
Mailing Address - Phone:310-740-6849
Mailing Address - Fax:754-323-4385
Practice Address - Street 1:16810 MERIDIAN E STE J107
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-9604
Practice Address - Country:US
Practice Address - Phone:253-848-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN122071223E0200X
GADN0141001223E0200X
WADE614534791223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics