Provider Demographics
NPI:1508874447
Name:JOHNSON, LENA (DDS)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:JOHNSON
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 1:50 WINDSORMERE WAY
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8256
Mailing Address - Country:US
Mailing Address - Phone:407-365-7482
Mailing Address - Fax:407-365-7441
Practice Address - Street 1:50 WINDSORMERE WAY
Practice Address - Street 2:SUITE 1020
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8256
Practice Address - Country:US
Practice Address - Phone:407-365-7482
Practice Address - Fax:407-365-7441
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15426122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist