Provider Demographics
NPI:1215594494
Name:JOHNSON, SOLANGE PEREZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:SOLANGE
Middle Name:PEREZ
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 1:2 E POINTE CT
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-1392
Mailing Address - Country:US
Mailing Address - Phone:334-347-3061
Mailing Address - Fax:
Practice Address - Street 1:2 E POINTE CT
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-1392
Practice Address - Country:US
Practice Address - Phone:334-347-3061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00070031223G0001X
390200000X
TX368801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program