MEDICARE: DR. EUGENIA JOHNSON

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	1223E0200X	Endodontics	50	OK

General Provider Information

NPI Number	:	1770713729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EUGENIA JOHNSON

Provider Business Mailing Address
First Line	:	4416 W HOUSTON ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-4645
Country	:	US
Telephone Number	:	918-615-3600
Fax Number	:	918-615-6301

Provider Business Practice Location Address
First Line	:	4416 W HOUSTON ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-4645
Country	:	US
Telephone Number	:	918-615-3600
Fax Number	:	918-615-3601

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

Provider Enumeration Date	:	07/23/2009
Last Update Date	:	07/23/2009

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