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NPI Code Detail

MEDICARE: DJR2 PROFESSIONAL LIMITED LIABILITY COMPANY

MEDICARE: DJR2 PROFESSIONAL LIMITED LIABILITY COMPANY
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
11223P0221XPediatric Dentistry

General Provider Information

NPI Number : 1831606094
Entity Type Code : Organization
Provider Name (Legal Business Name) : DJR2 PROFESSIONAL LIMITED LIABILITY COMPANY
Provider Business Mailing Address
First Line : 2505 LARKIN RD STE 201
Second Line :
City : LEXINGTON
State : KY
Zip : 40503-3256
Country : US
Telephone Number : 859-396-3347
Fax Number :
Provider Business Practice Location Address
First Line : 303 S 4TH ST STE 201
Second Line :
City : DANVILLE
State : KY
Zip : 40422-2091
Country : US
Telephone Number : 859-236-8448
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : DR. JEFFREY TODD JOHNSON
Credential : DMD, MPH
Telephone Number : 859-327-4711
Provider Enumeration Date : 01/09/2018
Last Update Date : 01/09/2018

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Directions to “DJR2 PROFESSIONAL LIMITED LIABILITY COMPANY ” Practice Location

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