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General NPI Number Information
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NPI Number | 1447964754
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Entity Type | Organization
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Legal Business Name | DR. LAREE JOHNSON PLLC
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Dates
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Enumeration Date | 01/11/2023
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 2620 NEW BERN AVE
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City | RALEIGH
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State | NC
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Zip | 27610-1821
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Country | US
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Telephone | 919-526-1000
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Fax | 833-516-9244
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Provider Business Mailing Address
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Address Line | 182 INDUSTRIAL RD
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City | GLEN ROCK
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State | PA
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Zip | 17327-8626
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Country | US
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Telephone | 717-759-4375
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Fax | 717-759-4336
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Authorized Official
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Title or Position | OWNER
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Name | LAREE JOHNSON
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Credential | DDS
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Telephone | 919-526-1000
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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 |
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License Number State |
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Taxonomy #2
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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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