Healthcare Provider Details

I. General information

NPI: 1861332389
Provider Name (Legal Business Name): SYDNEY PAIGE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N CLARK ST STE 600
CHICAGO IL
60654-4782
US

IV. Provider business mailing address

559 BOB O LINK DR
LEXINGTON KY
40503-1107
US

V. Phone/Fax

Practice location:
  • Phone: 312-274-0308
  • Fax:
Mailing address:
  • Phone: 502-322-4403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019037413
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: