MEDICARE: DR. DAVID CARL 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	DN10923	FL

General Provider Information

NPI Number	:	1497839500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID CARL JOHNSON DDS

Provider Business Mailing Address
First Line	:	8934 4TH STREET NORTH
Second Line	:	DAVID C JOHNSON DDS PA
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33702
Country	:	US
Telephone Number	:	727-576-3319
Fax Number	:

Provider Business Practice Location Address
First Line	:	8934 4TH STREET NORTH
Second Line	:	DAVID C JOHNSON DDS PA
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33702
Country	:	US
Telephone Number	:	727-576-3319
Fax Number	:

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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