Provider Demographics
NPI:1275634941
Name:JOHNSON, EVERETT R (DDS)
Entity Type:Individual
Prefix:DR
First Name:EVERETT
Middle Name:R
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 1:734 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-2777
Mailing Address - Country:US
Mailing Address - Phone:603-524-8159
Mailing Address - Fax:603-524-4506
Practice Address - Street 1:734 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2777
Practice Address - Country:US
Practice Address - Phone:603-524-8159
Practice Address - Fax:603-524-4506
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH31291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice