Healthcare Provider Details

I. General information

NPI: 1538232269
Provider Name (Legal Business Name): JOHNNY JOHNSON JR & ALEX J JOHNSON, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 TAMPA RD
PALM HARBOR FL
34684-3600
US

IV. Provider business mailing address

3840 TAMPA RD
PALM HARBOR FL
34684-3600
US

V. Phone/Fax

Practice location:
  • Phone: 727-786-7551
  • Fax:
Mailing address:
  • Phone: 727-786-7551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN9643
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN9640
License Number StateFL

VIII. Authorized Official

Name: MRS. TRISH JOHNSON
Title or Position: ACCOUNTING BOOKKEEPING
Credential:
Phone: 727-786-7551