Individual
DR. JACLYN NICOLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
202 TUNNELTON ST, STE 214, KINGWOOD, WV 26537-1452
(304) 329-1989
Mailing address
202 TUNNELTON ST, STE 214, KINGWOOD, WV 26537-1452
(304) 329-1989
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4171
WV
Other
Enumeration date
06/20/2015
Last updated
06/20/2015
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