MEDICARE: ROBERT W JOHNSON, D.D.S., INC

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
1	1223G0001X	General Practice Dentistry	DN7425	FL

General Provider Information

NPI Number	:	1366657041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT W JOHNSON, D.D.S., INC

Provider Business Mailing Address
First Line	:	1200 S 14TH ST
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-3043
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 S 14TH ST
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-3043
Country	:	US
Telephone Number	:	904-261-0851
Fax Number	:	904-261-5002

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT JOHNSON
Credential	:
Telephone Number	:	904-261-0851

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	08/22/2020

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