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General NPI Number Information
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NPI Number | 1649729724
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Entity Type | Organization
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Legal Business Name | MARIE JOHNSON, DDS, LLS
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Dates
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Enumeration Date | 09/29/2016
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 115 S WOLFE ST
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City | BALTIMORE
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State | MD
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Zip | 21231-1915
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Country | US
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Telephone | 202-368-5102
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Fax |
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Provider Business Mailing Address
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Address Line | 115 S WOLFE ST
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City | BALTIMORE
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State | MD
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Zip | 21231-1915
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Country | US
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Telephone | 202-368-5102
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIE NOELLE JOHNSON
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Credential | DDS
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Telephone | 202-368-5102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 13981
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License Number State | MD
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