Provider Demographics
NPI:1215349568
Name:LINDA JOHNSON DDS PLLC
Entity type:Organization
Organization Name:LINDA JOHNSON DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-363-1464
Mailing Address - Street 1:11066 5TH AVE NE
Mailing Address - Street 2:SUITE #202
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6156
Mailing Address - Country:US
Mailing Address - Phone:206-363-1464
Mailing Address - Fax:206-361-9559
Practice Address - Street 1:11066 5TH AVE NE
Practice Address - Street 2:SUITE #202
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6156
Practice Address - Country:US
Practice Address - Phone:206-363-1464
Practice Address - Fax:206-361-9559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00006861261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental