Provider Demographics
NPI:1467498782
Name:JOHNSON, LUCIA L (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUCIA
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S ARLINGTON ST
Mailing Address - Street 2:SUITE 38
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-3750
Mailing Address - Country:US
Mailing Address - Phone:330-724-5471
Mailing Address - Fax:330-724-0516
Practice Address - Street 1:1400 S ARLINGTON ST
Practice Address - Street 2:SUITE 38
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-3750
Practice Address - Country:US
Practice Address - Phone:330-724-5471
Practice Address - Fax:330-724-0516
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0219171223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2492440Medicaid