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General NPI Number Information
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NPI Number | 1497081459
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Entity Type | Organization
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Legal Business Name | VIP SMILES JOHNSON DENTAL INC
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 10/27/2009
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Provider Practice Location Address
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Address Line | 5260 WARRENSVILLE CTR RD
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City | MAPLE HEIGHTS
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State | OH
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Zip | 44137-1913
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Country | US
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Telephone | 216-475-0080
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Fax | 216-475-0778
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Provider Business Mailing Address
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Address Line | 5260 WARRENSVILLE CTR RD
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City | MAPLE HEIGHTS
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State | OH
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Zip | 44137-1913
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Country | US
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Telephone | 216-475-0080
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Fax | 216-475-0778
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Authorized Official
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Title or Position | CHAIRMAN
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Name | DR. LUCIA JOHNSON
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Credential | D.M.D.
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Telephone | 216-288-7560
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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 | 30-21917
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License Number State | OH
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