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General NPI Number Information
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NPI Number | 1346479987
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Entity Type | Organization
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Legal Business Name | ANDREW M JOHNSON DDS, PA
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Dates
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Enumeration Date | 07/03/2009
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Last Update Date | 07/03/2009
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Provider Practice Location Address
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Address Line | 2700 COLTSGATE RD SUITE 204
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City | CHARLOTTE
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State | NC
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Zip | 28211-3799
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Country | US
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Telephone | 704-749-5700
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Fax | 704-749-5701
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Provider Business Mailing Address
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Address Line | 2700 COLTSGATE RD SUITE 204
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City | CHARLOTTE
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State | NC
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Zip | 28211-3799
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Country | US
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Telephone | 704-749-5700
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Fax | 704-749-5701
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. ANDREW M JOHNSON
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Credential | DDS
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Telephone | 704-749-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 8388
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License Number State | NC
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