Provider Demographics
NPI:1518612696
Name:JOHANNA LERZUNDY DDS, PA
Entity Type:Organization
Organization Name:JOHANNA LERZUNDY DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LERZUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-667-8421
Mailing Address - Street 1:3505 TERAVISTA WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-9312
Mailing Address - Country:US
Mailing Address - Phone:919-667-8421
Mailing Address - Fax:
Practice Address - Street 1:1858 HILLANDALE RD STE 200
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2697
Practice Address - Country:US
Practice Address - Phone:919-471-1064
Practice Address - Fax:919-479-1841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental