MEDICARE: JOHNSON FAMILY DENTISTRY

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	DN0013457	FL

General Provider Information

NPI Number	:	1538346424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSON FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	1951 S ALAFAYA TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-8732
Country	:	US
Telephone Number	:	407-282-0002
Fax Number	:	407-282-1602

Provider Business Practice Location Address
First Line	:	1951 S ALAFAYA TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-8732
Country	:	US
Telephone Number	:	407-282-0002
Fax Number	:	407-282-1602

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. LUCIEN S. JOHNSON, 111
Credential	:	D.M.D.
Telephone Number	:	407-282-0002

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	01/23/2008

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