Provider Demographics
NPI:1992372841
Name:CATOE, JOHNNIE BRUCE
Entity Type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:BRUCE
Last Name:CATOE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3885 W ASHLEY CIR UNIT 640
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-9274
Mailing Address - Country:US
Mailing Address - Phone:843-212-2101
Mailing Address - Fax:
Practice Address - Street 1:3885 W ASHLEY CIR UNIT 640
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-9274
Practice Address - Country:US
Practice Address - Phone:843-212-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9884122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist