Provider Demographics
NPI:1306028899
Name:JOHNSON, REED E (DDS)
Entity Type:Individual
Prefix:DR
First Name:REED
Middle Name:E
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 1:410 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168
Mailing Address - Country:US
Mailing Address - Phone:317-839-3502
Mailing Address - Fax:317-838-9763
Practice Address - Street 1:410 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168
Practice Address - Country:US
Practice Address - Phone:317-839-3502
Practice Address - Fax:317-838-9763
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009024122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist