Provider Demographics
NPI:1427369891
Name:DR. ROBERT W. JOHNSON, L.L.C.
Entity Type:Organization
Organization Name:DR. ROBERT W. JOHNSON, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-253-0935
Mailing Address - Street 1:515 W WADDIL ST
Mailing Address - Street 2:POST OFFICE BOX 307
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-2648
Mailing Address - Country:US
Mailing Address - Phone:318-253-5141
Mailing Address - Fax:318-240-8735
Practice Address - Street 1:515 W WADDIL ST
Practice Address - Street 2:POST OFFICE BOX 307
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2648
Practice Address - Country:US
Practice Address - Phone:318-253-5141
Practice Address - Fax:318-240-8735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1823601Medicaid