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General NPI Number Information
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NPI Number | 1871896845
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Entity Type | Individual
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Provider Name | PAMELA J JOHNSON D.D.S
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Gender | Female
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Dates
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Enumeration Date | 12/14/2010
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Last Update Date | 12/14/2010
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Provider Practice Location Address
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Address Line | 545 PLAINFIELD RD SUITE D
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City | WILLOWBROOK
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State | IL
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Zip | 60527-7600
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Country | US
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Telephone | 630-887-1188
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Fax | 630-887-1968
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Provider Business Mailing Address
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Address Line | 545 PLAINFIELD RD SUITE D
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City | WILLOWBROOK
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State | IL
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Zip | 60527-7600
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Country | US
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Telephone | 630-887-1188
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Fax | 630-887-1968
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 021001589
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License Number State | IL
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