Provider Demographics
NPI:1750315180
Name:JOHNSON, AN-LOUISE (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:AN-LOUISE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-0363
Mailing Address - Country:US
Mailing Address - Phone:781-545-6565
Mailing Address - Fax:781-545-6597
Practice Address - Street 1:56 NEW DRIFTWAY
Practice Address - Street 2:SUITE 309
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-4533
Practice Address - Country:US
Practice Address - Phone:781-545-6565
Practice Address - Fax:781-545-6597
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207601223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA494138OtherTUFTS HEALTH PLAN
MA00020760OtherDELTA DENTAL
MA11477985OtherAETNA HEALTH CARE
MA98018OtherFALLON HEALTH CARE
MAX12124OtherBLUE CROSS AND BLUE SHIEL
MAAA37401OtherHARVARD PILGRAM HEALTH CA
MAV05596Medicare UPIN
MA11477985OtherAETNA HEALTH CARE