MEDICARE: DR. ELIZABETH K. JOHNSON D.D.S.

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	30-022372	OH
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	30-022372	OH

General Provider Information

NPI Number	:	1457460511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH K. JOHNSON D.D.S.

Provider Business Mailing Address
First Line	:	1900 CROWN PARK CT STE A
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-2407
Country	:	US
Telephone Number	:	614-451-1402
Fax Number	:	614-451-1409

Provider Business Practice Location Address
First Line	:	1900 CROWN PARK CT STE A
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-2407
Country	:	US
Telephone Number	:	614-451-1402
Fax Number	:	614-451-1409

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/21/2022

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