Provider Demographics
NPI:1588674402
Name:SAWIN-JOHNSON, SUSAN E (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:SAWIN-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 1:2525 SANDCREST BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3048
Mailing Address - Country:US
Mailing Address - Phone:812-372-6165
Mailing Address - Fax:802-372-3065
Practice Address - Street 1:2525 SANDCREST BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3048
Practice Address - Country:US
Practice Address - Phone:812-372-6165
Practice Address - Fax:802-372-3065
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120091461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice