Organization
SHANNON P JOHNSON DMD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANNON POLLY JOHNSON DMD (PRESIDENT)
(502) 957-9390
Entity
Organization
Contact information
Practice address
9510 ORMSBY STATION RD STE 203, LOUISVILLE, KY 40223-4083
(502) 805-0500
(502) 771-6041
Mailing address
2913 CREEKSIDE DR, LOUISVILLE, KY 40241-2106
(502) 957-9390
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/09/2020
Last updated
02/08/2022
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