Provider Demographics
NPI:1801215827
Name:CHAD E JOHNSON DDS PC
Entity Type:Organization
Organization Name:CHAD E JOHNSON DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-282-1030
Mailing Address - Street 1:2335 KNOB CREEK RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2002
Mailing Address - Country:US
Mailing Address - Phone:423-282-1030
Mailing Address - Fax:423-282-4714
Practice Address - Street 1:2335 KNOB CREEK RD
Practice Address - Street 2:SUITE 107
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2002
Practice Address - Country:US
Practice Address - Phone:423-282-1030
Practice Address - Fax:423-282-4714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8138122300000X
TN9466122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty