Provider Demographics
NPI:1649019050
Name:JOHNSON, CAROLINE ANN (DMD)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FAY MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01519-1420
Mailing Address - Country:US
Mailing Address - Phone:508-450-2895
Mailing Address - Fax:
Practice Address - Street 1:505 FRONT ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-3140
Practice Address - Country:US
Practice Address - Phone:413-420-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program