Provider Demographics
NPI:1124189998
Name:JOHNSON, JOHN F III (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:JOHNSON
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JACK
Other - Middle Name:FARLA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:277 ORISKANY BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492
Mailing Address - Country:US
Mailing Address - Phone:315-736-6456
Mailing Address - Fax:315-736-3309
Practice Address - Street 1:277 ORISKANY BLVD
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492
Practice Address - Country:US
Practice Address - Phone:315-736-6456
Practice Address - Fax:315-736-3309
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043500NY122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist