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NPI Code Detail

MEDICARE: EDWINA V. JOHNSON, D.D.S., P.C.

MEDICARE: EDWINA V. JOHNSON, D.D.S., P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryS 4606OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11316049141OTHEROKNPI INDIVIDUAL ID
2731231901001OTHEROKOTHER ID OK

General Provider Information

NPI Number : 1003003831
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDWINA V. JOHNSON, D.D.S., P.C.
Provider Business Mailing Address
First Line : 4200 HEMINGWAY DR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73118-2235
Country : US
Telephone Number : 405-557-1245
Fax Number :
Provider Business Practice Location Address
First Line : 4200 HEMINGWAY DR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73118-2235
Country : US
Telephone Number : 405-557-1245
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : MS. EDWINA VIRGINIA JOHNSON
Credential : D.D.S.
Telephone Number : 405-557-1245
Provider Enumeration Date : 09/25/2007
Last Update Date : 06/18/2008

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