Provider Demographics
NPI:1578677290
Name:JOHNS, TERESA (DMD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:JOHNS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 EAST COLONY DR
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751
Mailing Address - Country:US
Mailing Address - Phone:407-644-7075
Mailing Address - Fax:407-665-3408
Practice Address - Street 1:132 SAUSALITO BLVD
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5764
Practice Address - Country:US
Practice Address - Phone:407-665-3400
Practice Address - Fax:407-665-3408
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 172441223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN17244OtherLICENSE NUMBER