Provider Demographics
NPI:1114354818
Name:JOHNSON, JANELLE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANELLE
Middle Name:M
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 1:308 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-5715
Mailing Address - Country:US
Mailing Address - Phone:830-798-0844
Mailing Address - Fax:
Practice Address - Street 1:308 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-5715
Practice Address - Country:US
Practice Address - Phone:830-798-0844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29091122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist