Provider Demographics
NPI:1922049741
Name:JOHNSON, ALICE JANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:JANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7333 E HWY 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1526
Mailing Address - Country:US
Mailing Address - Phone:512-452-2195
Mailing Address - Fax:512-452-1871
Practice Address - Street 1:5802B BERKMAN DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-2625
Practice Address - Country:US
Practice Address - Phone:512-452-2195
Practice Address - Fax:512-452-1871
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice