Provider Demographics
NPI:1467977090
Name:JOHNSON-SHONE DENTISTRY LLC
Entity Type:Organization
Organization Name:JOHNSON-SHONE DENTISTRY LLC
Other - Org Name:MAGNOLIA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-631-6934
Mailing Address - Street 1:989 N US 31
Mailing Address - Street 2:
Mailing Address - City:WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-1379
Mailing Address - Country:US
Mailing Address - Phone:317-535-3080
Mailing Address - Fax:
Practice Address - Street 1:989 N US 31
Practice Address - Street 2:
Practice Address - City:WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-1379
Practice Address - Country:US
Practice Address - Phone:317-535-3080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental