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General NPI Number Information
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NPI Number | 1033385737
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Entity Type | Organization
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Legal Business Name | DRS JOHNSON TERRY & ASSOCIATES
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Dates
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Enumeration Date | 05/02/2008
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Last Update Date | 05/02/2008
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Provider Practice Location Address
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Address Line | 301 GASLIGHT DR
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City | VERSAILLES
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State | IN
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Zip | 47042-7322
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Country | US
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Telephone | 812-689-6522
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Fax |
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Provider Business Mailing Address
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Address Line | 301 GASLIGHT DR
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City | VERSAILLES
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State | IN
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Zip | 47042-7322
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Country | US
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Telephone | 812-689-6522
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Fax |
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Authorized Official
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Title or Position | SYSTEM MANAGER
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Name | LINDA L VANVOLKENBURGH
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Credential |
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Telephone | 812-689-7461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12008101
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License Number State | IN
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