Provider Demographics
NPI:1750517389
Name:JOHNSON, LAURA ELLEN SUTTON (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ELLEN SUTTON
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 1:6132 CAROLINA BEACH RD
Mailing Address - Street 2:SUITE 6 MASONBORO LANDING
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2788
Mailing Address - Country:US
Mailing Address - Phone:910-392-9101
Mailing Address - Fax:
Practice Address - Street 1:6132 CAROLINA BEACH RD
Practice Address - Street 2:SUITE 6 MASONBORO LANDING
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2788
Practice Address - Country:US
Practice Address - Phone:910-392-9101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8769122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist