Provider Demographics
NPI:1588810121
Name:J. B. JOHNSONIUS, D.D.S.
Entity Type:Organization
Organization Name:J. B. JOHNSONIUS, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:B
Authorized Official - Last Name:JOHNSONIUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:731-642-8540
Mailing Address - Street 1:304 DUNLAP ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-2501
Mailing Address - Country:US
Mailing Address - Phone:731-642-8540
Mailing Address - Fax:731-642-1943
Practice Address - Street 1:14815 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-6228
Practice Address - Country:US
Practice Address - Phone:731-352-2041
Practice Address - Fax:731-352-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty