Provider Demographics
NPI:1942495734
Name:WILSON-JOHNSON, TANYA REBECCA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:REBECCA
Last Name:WILSON-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 1:1700 17TH ST NW
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2453
Mailing Address - Country:US
Mailing Address - Phone:202-387-5090
Mailing Address - Fax:202-387-5095
Practice Address - Street 1:1700 17TH ST NW
Practice Address - Street 2:SUITE 305
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2453
Practice Address - Country:US
Practice Address - Phone:202-387-5090
Practice Address - Fax:202-387-5095
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDC4921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist