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NPI Code Detail

MEDICARE: DR. ALLAN CARL JOHNSON DMD

MEDICARE: DR. ALLAN CARL JOHNSON DMD
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 Dentistry4102MD

General Provider Information

NPI Number : 1063575520
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALLAN CARL JOHNSON DMD
Provider Business Mailing Address
First Line : 4605 69TH AVENUE
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20784-2123
Country : US
Telephone Number : 301-772-2224
Fax Number : 301-772-2289
Provider Business Practice Location Address
First Line : 4605 69TH AVENUE
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20784-2123
Country : US
Telephone Number : 301-772-2224
Fax Number : 301-772-2289
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2006
Last Update Date : 07/08/2007

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