Healthcare Provider Details

I. General information

NPI: 1801103163
Provider Name (Legal Business Name): TOMIKA JOHNSON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22847 COTTAGE GROVE AVE
STEGER IL
60475-6007
US

IV. Provider business mailing address

22847 COTTAGE GROVE AVE
STEGER IL
60475-6007
US

V. Phone/Fax

Practice location:
  • Phone: 708-357-3872
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number020.009980
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: