Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN14870 | FL |
NPI | 1023288255 |
---|---|
Provider Name | Dr. Paul David Johnson |
First Address | Palm Coast, FL 32164 |
Second Address | Palm Coast, FL 32164 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2008 |
Last Update Date | 04/03/2008 |