Provider Demographics
NPI:1316379266
Name:JOHNSON ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:JOHNSON ORTHODONTICS, PLLC
Other - Org Name:MEHAN AND JOHNSON ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-623-8003
Mailing Address - Street 1:113 MAMMOTH RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109
Mailing Address - Country:US
Mailing Address - Phone:603-623-8003
Mailing Address - Fax:603-623-1191
Practice Address - Street 1:113 MAMMOTH RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109
Practice Address - Country:US
Practice Address - Phone:603-623-8003
Practice Address - Fax:603-623-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH39741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty