Healthcare Provider Details

I. General information

NPI: 1346687282
Provider Name (Legal Business Name): AMBER MARIE HURLEY JOHNSON DMD, DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2013
Last Update Date: 06/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 12TH ST RM 238 OM: ORAL & MAXILLOFACIAL SURGERY CLINIC
RICHMOND VA
23298-5064
US

IV. Provider business mailing address

PO BOX 980566 OM: ORAL & MAXILLOFACIAL SURGERY
RICHMOND VA
23298-0566
US

V. Phone/Fax

Practice location:
  • Phone: 804-628-6637
  • Fax: 804-828-0056
Mailing address:
  • Phone: 804-828-3584
  • Fax: 804-828-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: