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Organization
JIMMIE LEE JOHNSON DMD PSC
Active
Organization
JIMMIE LEE JOHNSON DMD PSC
Active
Other names
PSC A Sub S Corporation
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JIMMIE LEE JOHNSON DMD (DENTIST)
(606) 723-3213
Entity
Organization
Contact information
Practice address
87 WILDWOOD PLACE, IRVINE, KY 40336-1312
(606) 723-3213
(606) 723-3213
Mailing address
PO BOX 175, 87 WILDWOOD PLACE, IRVINE, KY 40336-1312
(606) 723-3213
(606) 723-3213
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6163
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60061637
—
KY
Enumeration date
02/13/2007
Last updated
03/25/2008
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