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General NPI Number Information
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NPI Number | 1699783837
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Entity Type | Organization
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Legal Business Name | JOHNSON DENTAL GROUP, LLC
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 615 W. OGLETHORPE HWY
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City | HINESVILLE
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State | GA
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Zip | 31313
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Country | US
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Telephone | 912-877-3070
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Fax | 912-877-3082
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Provider Business Mailing Address
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Address Line | P. O. BOX 859
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City | HINESVILLE
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State | GA
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Zip | 31310
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Country | US
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Telephone | 912-877-3070
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Fax | 912-877-3082
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Authorized Official
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Title or Position | PRSIDENT CEO OF JOHNSON DENTAL GROU
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Name | DR. JOHN PAUL JOHNSON
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Credential | D.D.S.
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Telephone | 912-877-3070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN010850
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License Number State | GA
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