Healthcare Provider Details

I. General information

NPI: 1881768273
Provider Name (Legal Business Name): JOHNNA SUE BRITT D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 E FREDERICK ST
WALKERSVILLE MD
21793-8234
US

IV. Provider business mailing address

29 E FREDERICK ST
WALKERSVILLE MD
21793-8234
US

V. Phone/Fax

Practice location:
  • Phone: 310-845-4844
  • Fax:
Mailing address:
  • Phone: 310-845-4844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9896
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: