Provider Demographics
NPI:1508180977
Name:JOHNS, LAURIE MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:MARIE
Last Name:JOHNS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 WELLS RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2337
Mailing Address - Country:US
Mailing Address - Phone:904-579-3260
Mailing Address - Fax:904-278-0173
Practice Address - Street 1:1700 WELLS RD
Practice Address - Street 2:SUITE 7
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2337
Practice Address - Country:US
Practice Address - Phone:904-579-3260
Practice Address - Fax:904-278-0173
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 104241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice