Provider Demographics
NPI:1235214487
Name:JOHNSON, THOMAS BERKLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BERKLEY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 HOSPITAL DR
Mailing Address - Street 2:FAUQUIER COUNTY HEALTH DEPT
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186
Mailing Address - Country:US
Mailing Address - Phone:540-347-6400
Mailing Address - Fax:540-347-6405
Practice Address - Street 1:330 HOSPITAL DR
Practice Address - Street 2:FAUQUIER COUNTY HEALTH DEPT
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186
Practice Address - Country:US
Practice Address - Phone:540-347-6400
Practice Address - Fax:540-347-6405
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist