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Organization
JEAN D JOHNSON
Active
Organization
JEAN D JOHNSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN JOHNSON (OWNER)
(570) 458-6731
Entity
Organization
Contact information
Practice address
2201 5TH STREET HOLLOW RD STE 2, BLOOMSBURG, PA 17815-7757
(570) 458-6731
Mailing address
2201 5TH STREET HOLLOW RD STE 2, BLOOMSBURG, PA 17815-7757
(570) 458-6731
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
NULL
332BC3200X
Customized Equipment (DME)
—
NULL
Other
Enumeration date
09/28/2021
Last updated
09/28/2021
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