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General NPI Number Information
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NPI Number | 1194944975
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Entity Type | Individual
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Provider Name | LINDA G JOHNSON DMD
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1512 SANSOM ST
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City | PHILADELPHIA
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State | PA
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Zip | 19102-2804
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Country | US
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Telephone | 215-564-0717
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Fax | 215-564-5450
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Provider Business Mailing Address
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Address Line | 102 S KILDONAN GLN
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City | WILMINGTON
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State | DE
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Zip | 19807-1700
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Country | US
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Telephone | 302-654-8234
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Fax | 302-778-1773
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS026800-L
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License Number State | PA
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