Healthcare Provider Details

I. General information

NPI: 1649560418
Provider Name (Legal Business Name): ANDREW P JOHNSON, DMD,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 11TH ST NE
E WENATCHEE WA
98802-4481
US

IV. Provider business mailing address

101 11TH ST NE
EAST WENATCHEE WA
98802-4481
US

V. Phone/Fax

Practice location:
  • Phone: 509-884-7137
  • Fax:
Mailing address:
  • Phone: 509-884-7137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number00010277
License Number StateWA

VIII. Authorized Official

Name: ANDREW P JOHNSON
Title or Position: PRESIDENT
Credential: DMD
Phone: 509-679-5352