Provider Demographics
NPI:1356440150
Name:JOHNS, MARY H (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:H
Last Name:JOHNS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3642 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-6277
Mailing Address - Country:US
Mailing Address - Phone:931-526-6237
Mailing Address - Fax:
Practice Address - Street 1:121 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3547
Practice Address - Country:US
Practice Address - Phone:931-528-6547
Practice Address - Fax:931-528-3895
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS38151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice