Provider Demographics
NPI:1235353186
Name:JOHNSON, ROBIN D (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1172
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28111-1172
Mailing Address - Country:US
Mailing Address - Phone:704-242-3875
Mailing Address - Fax:
Practice Address - Street 1:104 S ASHE ST
Practice Address - Street 2:
Practice Address - City:KERSHAW
Practice Address - State:SC
Practice Address - Zip Code:29067-1402
Practice Address - Country:US
Practice Address - Phone:803-475-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8916122300000X
NC5359122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist