Provider Demographics
NPI:1699844522
Name:JOHNSON, PATRICK L (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:L
Last Name:JOHNSON
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 1:3314 EDWARDS CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-6097
Mailing Address - Country:US
Mailing Address - Phone:252-756-8971
Mailing Address - Fax:252-317-8335
Practice Address - Street 1:108 OAKMONT DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5936
Practice Address - Country:US
Practice Address - Phone:252-756-1456
Practice Address - Fax:252-317-8335
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC65731223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics