1750315180 NPI number — DR. AN-LOUISE JOHNSON DMD, MD

Table of content: DR. AN-LOUISE JOHNSON DMD, MD (NPI 1750315180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750315180 NPI number — DR. AN-LOUISE JOHNSON DMD, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
AN-LOUISE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD, MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1750315180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 363
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCITUATE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02066-0363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-545-6565
Provider Business Mailing Address Fax Number:
781-545-6597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56 NEW DRIFTWAY
Provider Second Line Business Practice Location Address:
SUITE 309
Provider Business Practice Location Address City Name:
SCITUATE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02066-4533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-545-6565
Provider Business Practice Location Address Fax Number:
781-545-6597
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  20760 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 494138 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 00020760 . This is a "DELTA DENTAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 11477985 . This is a "AETNA HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 98018 . This is a "FALLON HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: X12124 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA37401 . This is a "HARVARD PILGRAM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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