=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679776488
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENISE ANN HARBURG-JOHNSON DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 851 FRANKLIN LAKE ROAD SUITE 104
-----------------------------------------------------
City | FRANKLIN LAKES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07417-2242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-891-5888
-----------------------------------------------------
Fax | 201-891-1099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 851 FRANKLIN LAKE ROAD SUITE 104
-----------------------------------------------------
City | FRANKLIN LAKES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07417-2242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-891-5888
-----------------------------------------------------
Fax | 201-891-1099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DI15603
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------