Healthcare Provider Details

I. General information

NPI: 1669262721
Provider Name (Legal Business Name): HEATHER LEEANNA JOHNSON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2025
Last Update Date: 05/10/2025
Certification Date: 05/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 THOMAS JOHNSON DR
FREDERICK MD
21702-4398
US

IV. Provider business mailing address

17504 TRACT RD
EMMITSBURG MD
21727-9345
US

V. Phone/Fax

Practice location:
  • Phone: 301-846-0433
  • Fax:
Mailing address:
  • Phone: 304-886-7244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number8873
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: