Provider Demographics
NPI:1215009808
Name:JOHNSON, ANGELA J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:J
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 1:3915 CASCADE RD SW STE 120
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8519
Mailing Address - Country:US
Mailing Address - Phone:404-472-0425
Mailing Address - Fax:404-472-0669
Practice Address - Street 1:3915 CASCADE ROAD SUITE 120
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2750
Practice Address - Country:US
Practice Address - Phone:404-472-0425
Practice Address - Fax:404-472-0669
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011211122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist