Individual
DR. JACOB REECE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
3839 W CONGRESS ST STE B, LAFAYETTE, LA 70506-6000
(870) 826-1511
Mailing address
3839 W CONGRESS ST STE B, LAFAYETTE, LA 70506-6000
(870) 826-1511
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
7636
LA
Other
Enumeration date
01/03/2025
Last updated
01/03/2025
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