Provider Demographics
NPI:1699743013
Name:JOHNSON & MORRIS PLLC
Entity type:Organization
Organization Name:JOHNSON & MORRIS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDING PEDIATRIC DENTIST AND CO-O
Authorized Official - Prefix:DR
Authorized Official - First Name:EUPHEMIA
Authorized Official - Middle Name:LAREE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PLLC
Authorized Official - Phone:919-770-8833
Mailing Address - Street 1:2800 WAKEFIELD PINES DRIVE SUITE 110
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614
Mailing Address - Country:US
Mailing Address - Phone:919-570-0180
Mailing Address - Fax:919-570-0280
Practice Address - Street 1:2800 WAKEFIELD PINES DRIVE SUITE 110
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614
Practice Address - Country:US
Practice Address - Phone:919-570-0180
Practice Address - Fax:919-570-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014W0Medicaid
NC16997430313Medicaid
NC014W0OtherBLUE CROSS BLUE SHIELD