MEDICARE: DAVID JOHNSON DDS PA

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	261QD0000X	Dental Clinic/Center	6572	NC

General Provider Information

NPI Number	:	1457540346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID JOHNSON DDS PA

Provider Business Mailing Address
First Line	:	3301 HENDERSON DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-5231
Country	:	US
Telephone Number	:	910-938-4333
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 HENDERSON DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-5231
Country	:	US
Telephone Number	:	910-938-4333
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID WAYNE JOHNSON
Credential	:	D.D.S.
Telephone Number	:	910-938-4333

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	10/17/2007

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