Provider Demographics
NPI:1184656845
Name:JOHNSON, PAUL OLIVER (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:OLIVER
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-5971
Mailing Address - Country:US
Mailing Address - Phone:781-237-2151
Mailing Address - Fax:781-237-2133
Practice Address - Street 1:486 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-5971
Practice Address - Country:US
Practice Address - Phone:781-237-2151
Practice Address - Fax:781-237-2133
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA191871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry