Provider Demographics
NPI:1861018533
Name:JOHNSON, JENNA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DMD
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 7
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NH
Mailing Address - Zip Code:03584-0007
Mailing Address - Country:US
Mailing Address - Phone:603-788-2517
Mailing Address - Fax:603-788-2520
Practice Address - Street 1:22 BUNKER HILL ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NH
Practice Address - Zip Code:03584-3009
Practice Address - Country:US
Practice Address - Phone:603-788-2517
Practice Address - Fax:603-788-2520
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4559122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist