Provider Demographics
NPI:1821318908
Name:TESSA JOHNSON, DDS
Entity Type:Organization
Organization Name:TESSA JOHNSON, DDS
Other - Org Name:QUINCY FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TESSA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:217-223-7051
Mailing Address - Street 1:1891 MAINE ST
Mailing Address - Street 2:STE. 1
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4272
Mailing Address - Country:US
Mailing Address - Phone:217-223-7051
Mailing Address - Fax:217-223-7429
Practice Address - Street 1:1891 MAINE ST
Practice Address - Street 2:STE. 1
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4272
Practice Address - Country:US
Practice Address - Phone:217-223-7051
Practice Address - Fax:217-223-7429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty