Provider Demographics
NPI:1912361858
Name:JOHNSON, GAIL MARGARET (EPRDH)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:MARGARET
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:EPRDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85078 CHEZEM RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-9438
Mailing Address - Country:US
Mailing Address - Phone:805-405-6107
Mailing Address - Fax:
Practice Address - Street 1:85078 CHEZEM RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-9438
Practice Address - Country:US
Practice Address - Phone:805-405-6107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH7113124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist