Provider Demographics
NPI:1033131248
Name:JOHNSON, JOEL EARL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:EARL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 OFFICE PARK CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5957
Mailing Address - Country:US
Mailing Address - Phone:803-788-2555
Mailing Address - Fax:803-788-2554
Practice Address - Street 1:9 OFFICE PARK CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5957
Practice Address - Country:US
Practice Address - Phone:803-788-2555
Practice Address - Fax:803-788-2554
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice