MEDICARE: DR. LEO ALVA JOHNS 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	122300000X	Dentist	3941	NC

General Provider Information

NPI Number	:	1811156862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEO ALVA JOHNS DDS

Provider Business Mailing Address
First Line	:	226 WHITE OAK BLF
Second Line	:
City	:	STELLA
State	:	NC
Zip	:	28582-9757
Country	:	US
Telephone Number	:	252-393-2898
Fax Number	:

Provider Business Practice Location Address
First Line	:	2821 HWY 903 NORTH
Second Line	:
City	:	MAURY
State	:	NC
Zip	:	28554
Country	:	US
Telephone Number	:	252-747-8101
Fax Number	:

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

Provider Enumeration Date	:	06/05/2008
Last Update Date	:	06/05/2008

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