Provider Demographics
NPI:1437274883
Name:S. MEREDITH JOHNSON, JR., D.M.D. PC
Entity Type:Organization
Organization Name:S. MEREDITH JOHNSON, JR., D.M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:S.
Authorized Official - Middle Name:MEREDITH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:812-288-8880
Mailing Address - Street 1:2946 E 10TH ST
Mailing Address - Street 2:BUILDING B
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-5914
Mailing Address - Country:US
Mailing Address - Phone:812-288-8880
Mailing Address - Fax:
Practice Address - Street 1:2946 E 10TH ST
Practice Address - Street 2:BUILDING B
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-5914
Practice Address - Country:US
Practice Address - Phone:812-288-8880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN67851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty