Provider Demographics
NPI:1215077433
Name:JOHNSON, ALFRED CASBURN JR (DDS)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:CASBURN
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-0195
Mailing Address - Country:US
Mailing Address - Phone:803-628-1142
Mailing Address - Fax:803-628-5115
Practice Address - Street 1:1306 OLD FAIRHOPE CT
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745
Practice Address - Country:US
Practice Address - Phone:803-628-1142
Practice Address - Fax:803-628-5115
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice