Provider Demographics
NPI:1194811885
Name:JUDY ANN JOHNSON, DDS, PC
Entity type:Organization
Organization Name:JUDY ANN JOHNSON, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-647-0740
Mailing Address - Street 1:1030 STERLING AVENUE
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1265
Mailing Address - Country:US
Mailing Address - Phone:708-647-0740
Mailing Address - Fax:708-647-0741
Practice Address - Street 1:1030 STERLING AVENUE
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-1265
Practice Address - Country:US
Practice Address - Phone:708-647-0740
Practice Address - Fax:708-647-0741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190168211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty