Provider Demographics
NPI:1508989724
Name:JOHNSON, MARIANNE MARTIN (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:MARTIN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 CLARK COVE RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-9029
Mailing Address - Country:US
Mailing Address - Phone:704-528-0461
Mailing Address - Fax:
Practice Address - Street 1:3070 11TH AVENUE DR SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-8336
Practice Address - Country:US
Practice Address - Phone:828-695-5778
Practice Address - Fax:828-695-2101
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC43981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice