Provider Demographics
NPI:1184950347
Name:JOHNSON, WILLIAM JR
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6756 CHEW AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1910
Mailing Address - Country:US
Mailing Address - Phone:215-843-9409
Mailing Address - Fax:
Practice Address - Street 1:6756 CHEW AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1910
Practice Address - Country:US
Practice Address - Phone:215-843-9409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS015141-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist