Provider Demographics
NPI:1427639285
Name:JOHNSON, LAAEL (RDH)
Entity type:Individual
Prefix:
First Name:LAAEL
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:MORRISONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12962-2806
Mailing Address - Country:US
Mailing Address - Phone:518-534-2768
Mailing Address - Fax:
Practice Address - Street 1:96 FLAT ROCK RD
Practice Address - Street 2:
Practice Address - City:MORRISONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12962-2806
Practice Address - Country:US
Practice Address - Phone:518-534-2768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist