Individual
JIMMY DYLAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
5855 20TH ST, VERO BEACH, FL 32966-1020
(561) 396-2400
Mailing address
10648 PINE CONE LN, FORT PIERCE, FL 34945-2247
(772) 359-7639
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN29302
FL
1223G0001X
General Practice Dentistry
DN29302
FL
Other
Enumeration date
06/28/2024
Last updated
07/03/2024
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