Provider Demographics
NPI:1003025453
Name:JOHNSON AND MAHAN DENTAL CARE, PC
Entity Type:Organization
Organization Name:JOHNSON AND MAHAN DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-766-3260
Mailing Address - Street 1:1829 DARBY DR STE A
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-2622
Mailing Address - Country:US
Mailing Address - Phone:256-766-3260
Mailing Address - Fax:256-766-6364
Practice Address - Street 1:1829 DARBY DR STE A
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2622
Practice Address - Country:US
Practice Address - Phone:256-766-3260
Practice Address - Fax:256-766-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL53421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty