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General NPI Number Information
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NPI Number | 1801580907
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Entity Type | Individual
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Provider Name | CAITLYN JOHNSON DMD
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Gender | Female
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 340 HARRISON BRIDGE RD STE D
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-7133
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Country | US
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Telephone | 904-563-2491
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Fax |
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Provider Business Mailing Address
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Address Line | 170 WHITE LILLIE FARM RD
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City | MOORE
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State | SC
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Zip | 29369-9503
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Country | US
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Telephone | 904-563-2491
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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 | 10500
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License Number State | SC
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