Provider Demographics
NPI:1649576190
Name:LAKEWAY DENTAL CENTER PLLC
Entity Type:Organization
Organization Name:LAKEWAY DENTAL CENTER PLLC
Other - Org Name:DANA M. JOHNSON DMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:865-993-2225
Mailing Address - Street 1:1277 HIGHWAY 11W
Mailing Address - Street 2:
Mailing Address - City:BEAN STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37708-5810
Mailing Address - Country:US
Mailing Address - Phone:865-993-2225
Mailing Address - Fax:865-993-2225
Practice Address - Street 1:1277 HIGHWAY 11W
Practice Address - Street 2:
Practice Address - City:BEAN STATION
Practice Address - State:TN
Practice Address - Zip Code:37708-5810
Practice Address - Country:US
Practice Address - Phone:865-993-2225
Practice Address - Fax:865-993-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS92081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty