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General NPI Number Information
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NPI Number | 1134113764
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Entity Type | Individual
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Provider Name | DEBORAH KAY JOHNSON DDS
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Gender | Female
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 01/03/2013
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Provider Practice Location Address
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Address Line | 1016 BUCHANAN ST SE
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City | WASHINGTON
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State | DC
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Zip | 20374-5020
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Country | US
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Telephone | 202-433-2480
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Fax |
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Provider Business Mailing Address
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Address Line | 5419 FLINT TAVERN PL
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City | BURKE
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State | VA
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Zip | 22015-2109
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Country | US
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Telephone | 703-764-7220
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 0401-008325
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License Number State | VA
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