MEDICARE: MRS. JEANNINE ANN JOHNSON RDH

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	124Q00000X	Dental Hygienist	2451	SC

General Provider Information

NPI Number	:	1497608871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEANNINE ANN JOHNSON RDH

Provider Business Mailing Address
First Line	:	9228 MEDICAL PLAZA DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29406-9125
Country	:	US
Telephone Number	:	843-574-5693
Fax Number	:	843-764-4512

Provider Business Practice Location Address
First Line	:	9228 MEDICAL PLAZA DR
Second Line	:
City	:	N CHARLESTON
State	:	SC
Zip	:	29406-9125
Country	:	US
Telephone Number	:	843-574-5693
Fax Number	:	843-764-4512

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

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	02/17/2026

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