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General NPI Number Information
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NPI Number | 1932185790
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Entity Type | Individual
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Provider Name | RACQUEL JOHNSON D.M.D
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Gender | Female
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 108 BENTONS LODGE RD STE A
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City | SUMMERVILLE
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State | SC
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Zip | 29485-6336
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Country | US
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Telephone | 843-892-1098
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Fax | 843-725-1594
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Provider Business Mailing Address
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Address Line | 108 BENTONS LODGE RD STE A
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City | SUMMERVILLE
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State | SC
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Zip | 29485-6336
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Country | US
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Telephone | 843-892-1098
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Fax | 843-725-1594
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2901602491
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DI022019
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | G3-0000497
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License Number State | DE
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 10889
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11273
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License Number State | SC
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