Provider Demographics
NPI:1295837623
Name:JOHNSON FAMILY DENTAL ASSOCIATES INC
Entity Type:Organization
Organization Name:JOHNSON FAMILY DENTAL ASSOCIATES INC
Other - Org Name:GROUP DENTAL PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:VAN ESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-781-4511
Mailing Address - Street 1:501 FREEPORT RD
Mailing Address - Street 2:
Mailing Address - City:ASPINWALL
Mailing Address - State:PA
Mailing Address - Zip Code:15215
Mailing Address - Country:US
Mailing Address - Phone:412-781-4511
Mailing Address - Fax:412-781-4595
Practice Address - Street 1:501 FREEPORT ROAD
Practice Address - Street 2:
Practice Address - City:ASPINWALL
Practice Address - State:PA
Practice Address - Zip Code:15215-3252
Practice Address - Country:US
Practice Address - Phone:412-781-4511
Practice Address - Fax:412-781-4595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0014856L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty