Provider Demographics
NPI:1447628235
Name:TERRAL, JULIA WROTEN (RDH (REGISTERED DENT)
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:WROTEN
Last Name:TERRAL
Suffix:
Gender:F
Credentials:RDH (REGISTERED DENT
Other - Prefix:MRS
Other - First Name:JULIA
Other - Middle Name:ANN WROTEN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:5454 CYPRESS ST.
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291
Mailing Address - Country:US
Mailing Address - Phone:318-396-0054
Mailing Address - Fax:318-397-0850
Practice Address - Street 1:5454 CYPRESS ST.
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291
Practice Address - Country:US
Practice Address - Phone:318-396-0054
Practice Address - Fax:318-397-0850
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1574124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist