Provider Demographics
NPI:1366680381
Name:JOHNSON, JOHN WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
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 1:5121 FOREST DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-7085
Mailing Address - Country:US
Mailing Address - Phone:614-775-9300
Mailing Address - Fax:614-775-9309
Practice Address - Street 1:5121 FOREST DR
Practice Address - Street 2:SUITE A
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-7085
Practice Address - Country:US
Practice Address - Phone:614-775-9300
Practice Address - Fax:614-775-9309
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist