Provider Demographics
NPI:1316144231
Name:JOHNSON, JOAN CHRISTINE (DDS)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:CHRISTINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ROSS TER
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1474
Mailing Address - Country:US
Mailing Address - Phone:415-458-8859
Mailing Address - Fax:
Practice Address - Street 1:4 EMBARCADERO CTR
Practice Address - Street 2:LOBBY LEVEL
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-5900
Practice Address - Country:US
Practice Address - Phone:415-576-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30828122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist