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General NPI Number Information
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NPI Number | 1821346206
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Entity Type | Individual
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Provider Name | JUANITA LEE JOHNSON RDH
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Gender | Female
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 08/16/2012
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Provider Practice Location Address
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Address Line | 22831 26TH AVE S
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City | DES MOINES
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State | WA
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Zip | 98198-7115
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Country | US
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Telephone | 206-250-1784
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Fax | 206-878-0813
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Provider Business Mailing Address
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Address Line | PO BOX 3894
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City | KENT
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State | WA
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Zip | 98089-0394
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Country | US
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Telephone | 206-250-1784
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Fax | 206-878-0813
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH00002159
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License Number State | WA
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