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NPI Code Detail

MEDICARE: DR. JUSTIN LEE JOHNSON DDS

MEDICARE:  DR. JUSTIN LEE JOHNSON  DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry2007016529MO

General Provider Information

NPI Number : 1053516658
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUSTIN LEE JOHNSON DDS
Provider Business Mailing Address
First Line : 3551 AMAZONAS DR
Second Line :
City : JEFFERSON CITY
State : MO
Zip : 65109-5717
Country : US
Telephone Number : 573-634-2400
Fax Number :
Provider Business Practice Location Address
First Line : 3551 AMAZONAS DR
Second Line :
City : JEFFERSON CITY
State : MO
Zip : 65109-5717
Country : US
Telephone Number : 573-634-2400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2007
Last Update Date : 04/28/2014

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Directions to “ DR. JUSTIN LEE JOHNSON DDS” Practice Location

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