Individual
NITA F JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
6121 N HANLEY RD, BERKELEY, MO 63134-2003
(314) 615-0531
(314) 615-8303
Mailing address
6121 N HANLEY RD, BERKELEY, MO 63134-2003
(314) 615-0531
(314) 615-8303
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
013816
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
401814611
—
MO
Enumeration date
08/21/2006
Last updated
12/17/2012
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