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General NPI Number Information
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NPI Number | 1528514726
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Entity Type | Organization
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Legal Business Name | JEFFREY CHAD JOHNSON DDS PLLC
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 08/28/2016
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Provider Practice Location Address
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Address Line | 8840 BLAKENEY PROFESSIONAL DR STE 202
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City | CHARLOTTE
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State | NC
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Zip | 28277-6718
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Country | US
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Telephone | 704-688-0070
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Fax |
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Provider Business Mailing Address
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Address Line | 8840 BLAKENEY PROFESSIONAL DR, STE 202
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City | CHARLOTTE
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State | NC
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Zip | 28277
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Country | US
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Telephone | 704-688-0070
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | SUSAN JOHNSON
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Credential |
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Telephone | 704-743-7278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 8139
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License Number State | NC
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