MEDICARE: MS. ROSE MARY JOHNSON D.D.S.

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	DN21954	FL

General Provider Information

NPI Number	:	1750831087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSE MARY JOHNSON D.D.S.

Provider Business Mailing Address
First Line	:	4122 SEABREEZE DRIVE
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250
Country	:	US
Telephone Number	:	720-467-9222
Fax Number	:

Provider Business Practice Location Address
First Line	:	7740 POINT MEADOWS DR STE 4
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-9180
Country	:	US
Telephone Number	:	720-467-9222
Fax Number	:

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

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	08/06/2019

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