Healthcare Provider Details

I. General information

NPI: 1003989864
Provider Name (Legal Business Name): ALEX JOSEPH JOHNSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
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

466 WATERFORD CIR E
TARPON SPRINGS FL
34688-7204
US

V. Phone/Fax

Practice location:
  • Phone: 727-786-7550
  • Fax:
Mailing address:
  • Phone: 727-938-8226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN9640
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: