Provider Demographics
NPI:1609203652
Name:JOHNSON HEALTH CENTER
Entity Type:Organization
Organization Name:JOHNSON HEALTH CENTER
Other - Org Name:BEDFORD COMMUNITY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-455-2480
Mailing Address - Street 1:134 ELON RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:24572-1966
Mailing Address - Country:US
Mailing Address - Phone:434-455-2480
Mailing Address - Fax:
Practice Address - Street 1:600 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-2452
Practice Address - Country:US
Practice Address - Phone:434-929-1400
Practice Address - Fax:434-929-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-07
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1609203652Medicaid