Provider Demographics
NPI:1639516081
Name:JOHNSON, ALISON (DDS)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W AIRPORT HWY
Mailing Address - Street 2:P.O. BOX 270
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558-1441
Mailing Address - Country:US
Mailing Address - Phone:419-825-2525
Mailing Address - Fax:419-825-5067
Practice Address - Street 1:210 W AIRPORT HWY
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:OH
Practice Address - Zip Code:43558-1441
Practice Address - Country:US
Practice Address - Phone:419-825-2525
Practice Address - Fax:419-825-5067
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30023952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist