Provider Demographics
NPI:1700227907
Name:LERZUNDY, JOHANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:
Last Name:LERZUNDY
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 1:12 GROSBEAK LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2790
Mailing Address - Country:US
Mailing Address - Phone:919-667-8421
Mailing Address - Fax:
Practice Address - Street 1:12 GROSBEAK LN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2790
Practice Address - Country:US
Practice Address - Phone:919-667-8421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice