Provider Demographics
NPI:1629199443
Name:JOHNESSEE, JOHN SHREVE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SHREVE
Last Name:JOHNESSEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 RIDGELYN DR
Mailing Address - Street 2:
Mailing Address - City:DALLASTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17313-9741
Mailing Address - Country:US
Mailing Address - Phone:717-747-0115
Mailing Address - Fax:
Practice Address - Street 1:85 WYNTRE BROOKE DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4536
Practice Address - Country:US
Practice Address - Phone:717-747-0115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO17652L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice