Provider Demographics
NPI:1992833388
Name:ROBERT A. JOHNSON DDS
Entity Type:Organization
Organization Name:ROBERT A. JOHNSON DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-443-4484
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:139 PRINCE STREET
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560-0115
Mailing Address - Country:US
Mailing Address - Phone:804-443-4484
Mailing Address - Fax:804-443-9002
Practice Address - Street 1:139 PRINCE STREET
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560-0115
Practice Address - Country:US
Practice Address - Phone:804-443-4484
Practice Address - Fax:804-443-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401004109261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental