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General NPI Number Information
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NPI Number | 1598975971
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Entity Type | Individual
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Provider Name | SHANNON POLLY JOHNSON DMD
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 9510 ORMSBY STATION RD STE 203
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City | LOUISVILLE
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State | KY
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Zip | 40223-4083
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Country | US
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Telephone | 28-050-5005
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Fax | 502-771-6041
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Provider Business Mailing Address
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Address Line | 2913 CREEKSIDE DR
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City | LOUISVILLE
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State | KY
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Zip | 40241-2106
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Country | US
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Telephone | 502-957-9390
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN 17245
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License Number State | FL
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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 | 7939
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License Number State | KY
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