Provider Demographics
NPI:1558446799
Name:JOHNSON, VICKI HELEN (DDS)
Entity type:Individual
Prefix:DR
First Name:VICKI
Middle Name:HELEN
Last Name: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 1:6070 ROUTE 53
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3395
Mailing Address - Country:US
Mailing Address - Phone:630-963-4306
Mailing Address - Fax:630-963-9344
Practice Address - Street 1:6070 ROUTE 53
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3395
Practice Address - Country:US
Practice Address - Phone:630-963-4306
Practice Address - Fax:630-963-9344
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice