Individual
SAMANTHA JO JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1938 LYDA AVE, BOWLING GREEN, KY 42104-3326
(270) 843-5600
Mailing address
1938 LYDA AVE, BOWLING GREEN, KY 42104-3326
(270) 843-5600
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
9200
KY
1223E0200X
Endodontics
Primary
9200
KY
Other
Enumeration date
04/17/2012
Last updated
09/22/2016
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