Provider Demographics
NPI:1811156862
Name:JOHNS, LEO ALVA (DDS)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:ALVA
Last Name:JOHNS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 WHITE OAK BLF
Mailing Address - Street 2:
Mailing Address - City:STELLA
Mailing Address - State:NC
Mailing Address - Zip Code:28582-9757
Mailing Address - Country:US
Mailing Address - Phone:252-393-2898
Mailing Address - Fax:
Practice Address - Street 1:2821 HWY 903 NORTH
Practice Address - Street 2:
Practice Address - City:MAURY
Practice Address - State:NC
Practice Address - Zip Code:28554
Practice Address - Country:US
Practice Address - Phone:252-747-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist