Provider Demographics
NPI:1124042494
Name:JOHNSON, GEORGE F III (DMD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:F
Last Name:JOHNSON
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 S MAYO TRL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1546
Mailing Address - Country:US
Mailing Address - Phone:606-432-0187
Mailing Address - Fax:606-433-0900
Practice Address - Street 1:1098 S MAYO TRL
Practice Address - Street 2:SUITE 103
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1546
Practice Address - Country:US
Practice Address - Phone:606-432-0187
Practice Address - Fax:606-433-0900
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY83721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice