Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DS020635L | PA |
NPI | 1003985524 |
---|---|
Provider Name | Dr. Frederick Stephen Johnson |
First Address | Hummelstown, PA 17036 |
Second Address | Cleona, PA 17042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |