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NPI Code Detail

MEDICARE: DR. RYNE STEVEN JOHNSON DMD

MEDICARE: DR. RYNE STEVEN JOHNSON DMD
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
11223P0700XProsthodonticsMA 16753MA

General Provider Information

NPI Number : 1467455337
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RYNE STEVEN JOHNSON DMD
Provider Business Mailing Address
First Line : 109 BEE ST
Second Line :
City : CHARLESTON
State : SC
Zip : 29401-5703
Country : US
Telephone Number : 843-577-5011
Fax Number :
Provider Business Practice Location Address
First Line : 109 BEE ST
Second Line :
City : CHARLESTON
State : SC
Zip : 29401-5703
Country : US
Telephone Number : 843-577-5011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 05/11/2020

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