Provider Demographics
NPI:1922257120
Name:JOHNSON, JENNIFER HENKEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:HENKEL
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 1:9951 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-2536
Mailing Address - Country:US
Mailing Address - Phone:727-393-8855
Mailing Address - Fax:727-391-0395
Practice Address - Street 1:9951 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772
Practice Address - Country:US
Practice Address - Phone:727-393-8855
Practice Address - Fax:727-391-0395
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN145851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL192257120OtherGENERAL DENTISTRY