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General NPI Number Information
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NPI Number | 1447884408
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Entity Type | Individual
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Provider Name | ABIGAIL JOHNSON DDS
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Gender | Female
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Dates
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Enumeration Date | 02/28/2020
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Last Update Date | 11/21/2022
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Provider Practice Location Address
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Address Line | 308 HWY 110 N STE A
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City | WHITEHOUSE
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State | TX
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Zip | 75791-3112
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Country | US
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Telephone | 903-209-2747
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Fax |
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Provider Business Mailing Address
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Address Line | 812 CREPE MYRTLE LN
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City | LONGVIEW
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State | TX
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Zip | 75604-6909
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Country | US
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Telephone | 602-459-4403
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 37159
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License Number State | TX
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