MEDICARE: CHARMAINE JOHNSON-LEONG, DDS, PA

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
1	1223G0001X	General Practice Dentistry	DN15991	FL

General Provider Information

NPI Number	:	1093805921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARMAINE JOHNSON-LEONG, DDS, PA

Provider Business Mailing Address
First Line	:	2655 E OAKLAND PARK BLVD
Second Line	:	SUITE 1
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1662
Country	:	US
Telephone Number	:	954-566-7479
Fax Number	:	954-565-0450

Provider Business Practice Location Address
First Line	:	2655 E OAKLAND PARK BLVD
Second Line	:	SUITE 1
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1662
Country	:	US
Telephone Number	:	954-566-7479
Fax Number	:	954-565-0450

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. CHARMAINE JOHNSON-LEONG
Credential	:	DDS
Telephone Number	:	954-566-7479

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	08/22/2020

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