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NPI Code Detail

MEDICARE: MOSES JOHNSON DDS

MEDICARE: MOSES 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
11223D0001XPublic Health DentistryDN14317FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DN14317OTHERFLMEDICAL LICENSE

General Provider Information

NPI Number : 1811047715
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOSES JOHNSON DDS
Provider Business Mailing Address
First Line : 5150 NW MILNER DR
Second Line :
City : PORT ST LUCIE
State : FL
Zip : 34983-3392
Country : US
Telephone Number : 772-462-3833
Fax Number : 772-462-3865
Provider Business Practice Location Address
First Line : 714 AVENUE C
Second Line :
City : FORT PIERCE
State : FL
Zip : 34950-4189
Country : US
Telephone Number : 772-462-3833
Fax Number : 772-462-3865
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2007
Last Update Date : 07/09/2007

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