Provider Demographics
NPI:1164917365
Name:JOHNSON, PRISCILLA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
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 1:1244 PERIMETER PKWY STE 442
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5699
Mailing Address - Country:US
Mailing Address - Phone:757-716-3539
Mailing Address - Fax:757-716-3546
Practice Address - Street 1:1244 PERIMETER PKWY STE 442
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5699
Practice Address - Country:US
Practice Address - Phone:757-716-3539
Practice Address - Fax:757-716-3546
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014171671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice