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General NPI Number Information
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NPI Number | 1831606094
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Entity Type | Organization
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Legal Business Name | DJR2 PROFESSIONAL LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 01/09/2018
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Provider Practice Location Address
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Address Line | 303 S 4TH ST STE 201
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City | DANVILLE
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State | KY
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Zip | 40422-2091
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Country | US
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Telephone | 859-236-8448
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Fax |
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Provider Business Mailing Address
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Address Line | 2505 LARKIN RD STE 201
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City | LEXINGTON
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State | KY
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Zip | 40503-3256
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Country | US
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Telephone | 859-396-3347
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JEFFREY TODD JOHNSON
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Credential | DMD, MPH
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Telephone | 859-327-4711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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