MEDICARE: DR. DEBORAH KAY 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
1	1223P0300X	Periodontics	0401-008325	VA

General Provider Information

NPI Number	:	1134113764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH KAY JOHNSON DDS

Provider Business Mailing Address
First Line	:	5419 FLINT TAVERN PL
Second Line	:
City	:	BURKE
State	:	VA
Zip	:	22015-2109
Country	:	US
Telephone Number	:	703-764-7220
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 BUCHANAN ST SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20374-5020
Country	:	US
Telephone Number	:	202-433-2480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	01/03/2013

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