Organization
ALICE J JOHNSON, DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALICE J JOHNSON DDS (PRESIDENT/OWNER)
(512) 452-2195
Entity
Organization
Contact information
Practice address
5802 BERKAMN DR, SUITE B, AUSTIN, TX 78723-2625
(512) 452-2195
(512) 452-1871
Mailing address
5802 BERKAMN DR, SUITE B, AUSTIN, TX 78723-2625
(512) 452-2195
(512) 452-1871
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
17654
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19922049741
NPI
TX
Enumeration date
10/13/2011
Last updated
10/13/2011
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