Provider Demographics
NPI:1932295540
Name:JOHNSON, ERIC ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ANDREW
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 OLD MILTON PKWY
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4435
Mailing Address - Country:US
Mailing Address - Phone:770-663-3436
Mailing Address - Fax:770-777-2328
Practice Address - Street 1:3990 OLD MILTON PKWY
Practice Address - Street 2:SUITE #1
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4435
Practice Address - Country:US
Practice Address - Phone:770-663-3436
Practice Address - Fax:770-777-2328
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0124781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice