Provider Demographics
NPI:1396158705
Name:JOHNSON, JEANETTE MARION (DDS)
Entity type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:MARION
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 1:5605 NEWCASTLE ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2712
Mailing Address - Country:US
Mailing Address - Phone:716-238-2041
Mailing Address - Fax:
Practice Address - Street 1:7500 CAMBRIDGE ST SUITE 6510
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:713-486-4052
Practice Address - Fax:713-486-4333
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program