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General NPI Number Information
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NPI Number | 1497829758
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Entity Type | Organization
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Legal Business Name | G TERRY JOHNSON DDS PA
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 03/30/2012
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Provider Practice Location Address
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Address Line | 146 DOCTORS ST
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City | SPARTA
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State | NC
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Zip | 28675
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Country | US
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Telephone | 336-372-8299
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Fax | 336-372-2291
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Provider Business Mailing Address
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Address Line | PO BOX 98 146 DOCTORS ST
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City | SPARTA
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State | NC
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Zip | 28675
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Country | US
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Telephone | 336-372-8299
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Fax | 336-372-2291
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Authorized Official
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Title or Position | OWNER
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Name | DR. G TERRY JOHNSON
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Credential | DDS
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Telephone | 336-372-8299
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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 | 200001371089
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License Number State | NC
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