Provider Demographics
NPI:1669847059
Name:JOHNSON, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3182 C.R. 418
Mailing Address - Street 2:
Mailing Address - City:LAKE PANASOFFKEE
Mailing Address - State:FL
Mailing Address - Zip Code:33538
Mailing Address - Country:US
Mailing Address - Phone:386-793-3298
Mailing Address - Fax:
Practice Address - Street 1:8900 MULBERRY LN
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162
Practice Address - Country:US
Practice Address - Phone:352-674-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8013126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant