1295837623 NPI number — JOHNSON FAMILY DENTAL ASSOCIATES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295837623 NPI number — JOHNSON FAMILY DENTAL ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNSON FAMILY DENTAL ASSOCIATES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GROUP DENTAL PRACTICE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295837623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 FREEPORT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASPINWALL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-781-4511
Provider Business Mailing Address Fax Number:
412-781-4595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 FREEPORT ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASPINWALL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15215-3252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-781-4511
Provider Business Practice Location Address Fax Number:
412-781-4595
Provider Enumeration Date:
09/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VAN ESSEN
Authorized Official First Name:
KATIE
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
412-781-4511

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DS0014856L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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