Provider Demographics
NPI:1598225161
Name:JOHNSON VAN GEMERT, PLLC
Entity Type:Organization
Organization Name:JOHNSON VAN GEMERT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN GEMERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:734-770-9029
Mailing Address - Street 1:4015 S MORRILL ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-1282
Mailing Address - Country:US
Mailing Address - Phone:734-770-9029
Mailing Address - Fax:
Practice Address - Street 1:520 S COWLEY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1315
Practice Address - Country:US
Practice Address - Phone:509-688-0688
Practice Address - Fax:509-340-8939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty