Provider Demographics
NPI:1912347808
Name:JOHNSON DENTAL ASSOCIATES, PLLS
Entity Type:Organization
Organization Name:JOHNSON DENTAL ASSOCIATES, PLLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MARCUM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-237-3655
Mailing Address - Street 1:199 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164-1120
Mailing Address - Country:US
Mailing Address - Phone:270-237-3655
Mailing Address - Fax:
Practice Address - Street 1:199 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-1120
Practice Address - Country:US
Practice Address - Phone:270-237-3655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty