Provider Demographics
NPI:1699787143
Name:JOHNSON, LINDA J (DDS)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:J
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 1:2706 ALT 19
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-2662
Mailing Address - Country:US
Mailing Address - Phone:727-785-4716
Mailing Address - Fax:
Practice Address - Street 1:2706 ALT 19
Practice Address - Street 2:SUITE 107
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-2662
Practice Address - Country:US
Practice Address - Phone:727-785-4716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8136122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist