Provider Demographics
NPI:1366620783
Name:JOHNSON, GARY JOHN (DDS)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:JOHN
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 1:60 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4501
Mailing Address - Country:US
Mailing Address - Phone:717-262-0093
Mailing Address - Fax:717-263-0051
Practice Address - Street 1:60 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4501
Practice Address - Country:US
Practice Address - Phone:717-262-0093
Practice Address - Fax:717-263-0051
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0444811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics