Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 0401-008325 | VA |
NPI | 1134113764 |
---|---|
Provider Name | Dr. Deborah Kay Johnson |
First Address | Burke, VA 22015-2109 |
Second Address | Washington, DC 20374-5020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 03/01/2013 |