Provider Demographics
NPI:1831606094
Name:DJR2 PROFESSIONAL LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:DJR2 PROFESSIONAL LIMITED LIABILITY COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MPH
Authorized Official - Phone:859-327-4711
Mailing Address - Street 1:2505 LARKIN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3256
Mailing Address - Country:US
Mailing Address - Phone:859-396-3347
Mailing Address - Fax:
Practice Address - Street 1:303 S 4TH ST STE 201
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2091
Practice Address - Country:US
Practice Address - Phone:859-236-8448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty