Provider Demographics
NPI:1144230632
Name:JOHNSON, JANICE RUTH (DMD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:RUTH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 MARIETTA AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552-3105
Mailing Address - Country:US
Mailing Address - Phone:717-653-6768
Mailing Address - Fax:
Practice Address - Street 1:28 N BARBARA ST
Practice Address - Street 2:
Practice Address - City:MOUNT JOY
Practice Address - State:PA
Practice Address - Zip Code:17552-1402
Practice Address - Country:US
Practice Address - Phone:717-653-2404
Practice Address - Fax:717-653-0022
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023290L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice