MEDICARE: GEORGE J JOHNSONJR.D.D.S.,PA

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1740615186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE J JOHNSONJR.D.D.S.,PA

Provider Business Mailing Address
First Line	:	2420 S 51ST CT STE A
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3669
Country	:	US
Telephone Number	:	479-452-2995
Fax Number	:	479-452-2145

Provider Business Practice Location Address
First Line	:	2420 S 51ST CT STE A
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3669
Country	:	US
Telephone Number	:	479-452-2995
Fax Number	:	479-452-2145

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GEORGE J JOHNSON JR.
Credential	:	D.D.S,
Telephone Number	:	479-452-2995

Provider Enumeration Date	:	09/04/2013
Last Update Date	:	09/04/2013

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