Provider Demographics
NPI:1356461081
Name:JOHNSON, LUCIEN SAMUEL III (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUCIEN
Middle Name:SAMUEL
Last Name:JOHNSON
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 S ALAFAYA TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8732
Mailing Address - Country:US
Mailing Address - Phone:407-282-0002
Mailing Address - Fax:407-282-1602
Practice Address - Street 1:1951 S ALAFAYA TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8732
Practice Address - Country:US
Practice Address - Phone:407-282-0002
Practice Address - Fax:407-282-1602
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00134571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice