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General NPI Number Information
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NPI Number | 1316379266
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Entity Type | Organization
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Legal Business Name | JOHNSON ORTHODONTICS, PLLC
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Dates
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Enumeration Date | 08/02/2013
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Last Update Date | 08/08/2013
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Provider Practice Location Address
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Address Line | 113 MAMMOTH RD SUITE 1
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City | MANCHESTER
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State | NH
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Zip | 03109
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Country | US
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Telephone | 603-623-8003
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Fax | 603-623-1191
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Provider Business Mailing Address
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Address Line | 113 MAMMOTH RD SUITE 1
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City | MANCHESTER
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State | NH
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Zip | 03109
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Country | US
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Telephone | 603-623-8003
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Fax | 603-623-1191
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Authorized Official
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Title or Position | OWNER
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Name | PAUL DAVID JOHNSON III
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Credential | DMD
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Telephone | 603-623-8003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3974
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License Number State | NH
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