Provider Demographics
NPI:1346687282
Name:JOHNSON, AMBER MARIE HURLEY (DMD, DO)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE HURLEY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DMD, DO
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 980566
Mailing Address - Street 2:OM: ORAL & MAXILLOFACIAL SURGERY
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0566
Mailing Address - Country:US
Mailing Address - Phone:804-828-3584
Mailing Address - Fax:804-828-0056
Practice Address - Street 1:520 N 12TH ST RM 238
Practice Address - Street 2:OM: ORAL & MAXILLOFACIAL SURGERY CLINIC
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5064
Practice Address - Country:US
Practice Address - Phone:804-628-6637
Practice Address - Fax:804-828-0056
Is Sole Proprietor?:No
Enumeration Date:2013-06-02
Last Update Date:2013-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program