Provider Demographics
NPI:1003985524
Name:JOHNSON, FREDERICK STEPHEN (DMD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:STEPHEN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2071 GRAMERCY PLACE
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036
Mailing Address - Country:US
Mailing Address - Phone:717-269-9711
Mailing Address - Fax:
Practice Address - Street 1:221 W PENN AVE
Practice Address - Street 2:STE 213
Practice Address - City:CLEONA
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:717-272-8500
Practice Address - Fax:717-272-6101
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020635L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist