Provider Demographics
NPI:1457450165
Name:AN-LOUISE JOHNSON DMD MD PC
Entity Type:Organization
Organization Name:AN-LOUISE JOHNSON DMD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AN-LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MD
Authorized Official - Phone:781-545-6565
Mailing Address - Street 1:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-0363
Mailing Address - Country:US
Mailing Address - Phone:781-545-6565
Mailing Address - Fax:781-545-6597
Practice Address - Street 1:56 NEW DRIFTWAY
Practice Address - Street 2:SUITE 309
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-4533
Practice Address - Country:US
Practice Address - Phone:781-545-6565
Practice Address - Fax:781-545-6597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207601223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA494138OtherTUFTS HEALTH CARE
MA98018OtherFALON HEALTH CARE
11477985OtherAETNA MEDICAL
AA37401OtherHARVARD PILGRIM
X12124OtherBCBS MEDICAL AND DENTAL
MA00020760OtherDELTA DENTAL OF MA
MAX20146Medicare ID - Type Unspecified
X12124OtherBCBS MEDICAL AND DENTAL