Provider Demographics
NPI:1740615186
Name:GEORGE J JOHNSONJR.D.D.S.,PA
Entity Type:Organization
Organization Name:GEORGE J JOHNSONJR.D.D.S.,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS,
Authorized Official - Phone:479-452-2995
Mailing Address - Street 1:2420 S 51ST CT STE A
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3669
Mailing Address - Country:US
Mailing Address - Phone:479-452-2995
Mailing Address - Fax:479-452-2145
Practice Address - Street 1:2420 S 51ST CT STE A
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3669
Practice Address - Country:US
Practice Address - Phone:479-452-2995
Practice Address - Fax:479-452-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental