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General NPI Number Information
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NPI Number | 1154987360
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Entity Type | Organization
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Legal Business Name | JOHNSON AND KNOX DENTCARE ASSOCIATES
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 05/13/2019
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Provider Practice Location Address
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Address Line | 9547A FAIRFAX BLVD
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City | FAIRFAX
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State | VA
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Zip | 22031-4740
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Country | US
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Telephone | 571-354-0849
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Fax |
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Provider Business Mailing Address
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Address Line | 5628 WOODYARD RD
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City | UPPER MARLBORO
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State | MD
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Zip | 20772-3880
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Country | US
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Telephone | 708-645-6311
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RASHEEDA JOHNSON
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Credential | DDS
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Telephone | 516-304-4717
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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 |
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License Number State |
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