Provider Demographics
NPI:1790836112
Name:JOHNSON, GEOFFREY EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:EDWARD
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 1:312 JOHNSON OAKES RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-8635
Mailing Address - Country:US
Mailing Address - Phone:434-836-1826
Mailing Address - Fax:
Practice Address - Street 1:177 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-3419
Practice Address - Country:US
Practice Address - Phone:434-797-1853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA82211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice