Provider Demographics
NPI:1639112766
Name:JOHNSON, JO-ANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JO-ANNE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JO-ANNE
Other - Middle Name:
Other - Last Name:LAVOIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:174 RTE 101
Mailing Address - Street 2:UNIT C-1
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110
Mailing Address - Country:US
Mailing Address - Phone:603-471-6000
Mailing Address - Fax:603-471-6022
Practice Address - Street 1:174 RTE 101
Practice Address - Street 2:UNIT C-1
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110
Practice Address - Country:US
Practice Address - Phone:603-471-6000
Practice Address - Fax:603-471-6022
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH26001223G0001X
NHNH2600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice