Organization
THE DENTISTS CLINIC
Active
Other names
ISA Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY CHARLES JOHNSON DDS (GENERAL PARTNER)
(671) 646-7982
Entity
Organization
Contact information
Practice address
761 S MARINE CORPS DRIVE, SUITE A-2 CENTAM BUILDING, TAMUNING, GU 96913
(671) 646-7982
(671) 646-7989
Mailing address
PO BOX W, HAGATNA, GU 96932
(671) 646-7982
(671) 646-7989
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D 829
GU
1223P0221X
Pediatric Dentistry
D 901
GU
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
185
—
GU
01
—
555029
HAWAII DENTAL SERVICES
HI
Enumeration date
08/28/2007
Last updated
08/28/2007
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