MEDICARE: DR. LINDA SUE 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	1223G0001X	General Practice Dentistry	6861	WA

General Provider Information

NPI Number	:	1427053925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA SUE JOHNSON DDS

Provider Business Mailing Address
First Line	:	11066 5TH AVE NE
Second Line	:	SUITE 202
City	:	SEATTLE
State	:	WA
Zip	:	98125-6189
Country	:	US
Telephone Number	:	206-363-1464
Fax Number	:	206-361-9559

Provider Business Practice Location Address
First Line	:	11066 5TH AVE NE
Second Line	:	SUITE 202
City	:	SEATTLE
State	:	WA
Zip	:	98125-6189
Country	:	US
Telephone Number	:	206-363-1464
Fax Number	:	206-361-9559

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	02/20/2014

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