Provider Demographics
NPI:1922241595
Name:JOHNSON, DENNIS L (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CROWN PARK CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-2407
Mailing Address - Country:US
Mailing Address - Phone:614-451-1402
Mailing Address - Fax:614-451-1408
Practice Address - Street 1:1900 CROWN PARK CT
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-2407
Practice Address - Country:US
Practice Address - Phone:614-451-1402
Practice Address - Fax:614-451-1408
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH138021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics