Provider Demographics
NPI:1093883670
Name:JOHNSON, JANE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-1116
Mailing Address - Country:US
Mailing Address - Phone:304-645-3883
Mailing Address - Fax:304-645-2109
Practice Address - Street 1:327 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1116
Practice Address - Country:US
Practice Address - Phone:304-645-3883
Practice Address - Fax:304-645-2109
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice