Provider Demographics
NPI:1811021025
Name:JOHNS, STEPHEN SMITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:SMITH
Last Name:JOHNS
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:RR 6 BOX 333
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-8830
Mailing Address - Country:US
Mailing Address - Phone:304-472-2774
Mailing Address - Fax:304-472-3927
Practice Address - Street 1:RR 6 BOX 333
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-8830
Practice Address - Country:US
Practice Address - Phone:304-472-2774
Practice Address - Fax:304-472-3927
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV23541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0135366000Medicaid
WVWV2354OtherSTATE LISCENSE NUMBER
WVWV2354OtherSTATE LISCENSE NUMBER