MEDICARE: ELLEN S 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	1223G0001X	General Practice Dentistry	12010292A	IN

General Provider Information

NPI Number	:	1952469942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN S JOHNS DDS

Provider Business Mailing Address
First Line	:	5019 HUNTINGTON DR
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46033-5935
Country	:	US
Telephone Number	:	317-569-1663
Fax Number	:

Provider Business Practice Location Address
First Line	:	1619 W 86TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2105
Country	:	US
Telephone Number	:	317-872-5104
Fax Number	:

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	12/16/2011

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