MEDICARE: CHARMAINE JOHNSON-LEONG

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	122300000X	Dentist	DN15991	FL

General Provider Information

NPI Number	:	1497134480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARMAINE JOHNSON-LEONG

Provider Business Mailing Address
First Line	:	2717 E OAKLAND PARK BLVD
Second Line	:	SUITE 100
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1664
Country	:	US
Telephone Number	:	954-566-7479
Fax Number	:	954-306-6910

Provider Business Practice Location Address
First Line	:	2717 E OAKLAND PARK BLVD
Second Line	:	SUITE 100
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1664
Country	:	US
Telephone Number	:	954-566-7479
Fax Number	:	954-306-6910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2015
Last Update Date	:	05/08/2025

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