Provider Demographics
NPI:1053483321
Name:JOHNSON, MARC D (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:D
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 1:501 FREEPORT RD
Mailing Address - Street 2:FOX CHAPEL FAMILY DENTAL
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15215
Mailing Address - Country:US
Mailing Address - Phone:412-781-4511
Mailing Address - Fax:412-781-4595
Practice Address - Street 1:501 FREEPORT RD
Practice Address - Street 2:FOX CHAPEL FAMILY DENTAL
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215
Practice Address - Country:US
Practice Address - Phone:412-781-4511
Practice Address - Fax:412-781-4595
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0350421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice