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General NPI Number Information
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NPI Number | 1255752614
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Entity Type | Organization
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Legal Business Name | JOHNSON FAMILY DENTISTRY
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Dates
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Enumeration Date | 01/02/2014
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Last Update Date | 01/02/2014
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Provider Practice Location Address
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Address Line | 722 HARVARD DR
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City | OWENSBORO
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State | KY
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Zip | 42301-6152
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Country | US
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Telephone | 270-685-5242
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Fax | 270-685-5247
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Provider Business Mailing Address
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Address Line | 722 HARVARD DR
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City | OWENSBORO
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State | KY
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Zip | 42301-6152
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Country | US
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Telephone | 270-685-5242
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Fax | 270-685-5247
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MATTHEW JOHNSON
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Credential | DMD
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Telephone | 270-685-5242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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