Provider Demographics
NPI:1285644641
Name:JOHNSON, WAYNE LOFTON (DDS)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:LOFTON
Last Name:JOHNSON
Suffix:
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 1:401 W MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3584
Mailing Address - Country:US
Mailing Address - Phone:615-444-2034
Mailing Address - Fax:615-449-6206
Practice Address - Street 1:401 W MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3584
Practice Address - Country:US
Practice Address - Phone:615-444-2034
Practice Address - Fax:615-449-6206
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS-1837122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist