Healthcare Provider Details

I. General information

NPI: 1760513675
Provider Name (Legal Business Name): SARAH FOARD JOHNSON D.M.D,,CDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2934 BRECKENRIDGE LN STE 1
LOUISVILLE KY
40220-3903
US

IV. Provider business mailing address

2934 BRECKENRIDGE LN STE 1
LOUISVILLE KY
40220-3903
US

V. Phone/Fax

Practice location:
  • Phone: 502-459-2000
  • Fax: 502-459-4854
Mailing address:
  • Phone: 502-459-2000
  • Fax: 502-459-4854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberKY6887
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: