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General NPI Number Information
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NPI Number | 1487750964
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Entity Type | Individual
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Provider Name | EDWARD L. JOHNSON D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 928 STATE ROUTE 716
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City | ASHLAND
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State | KY
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Zip | 41102-9231
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Country | US
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Telephone | 606-928-3866
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Fax | 606-928-3848
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Provider Business Mailing Address
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Address Line | 928 STATE ROUTE 716
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City | ASHLAND
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State | KY
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Zip | 41102-9231
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Country | US
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Telephone | 606-928-3866
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Fax | 606-928-3848
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5483
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License Number State | KY
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