Provider Demographics
NPI:1235269911
Name:JOHNSON, MARK ALLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
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 1:2213 CURLEW RD
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-9324
Mailing Address - Country:US
Mailing Address - Phone:727-437-7774
Mailing Address - Fax:727-437-7714
Practice Address - Street 1:2213 CURLEW RD
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-9324
Practice Address - Country:US
Practice Address - Phone:727-437-7774
Practice Address - Fax:727-437-7714
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17613122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist