Individual
NICOLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1600 W LANE AVE UNIT 310, UPPER ARLINGTON, OH 43221-3966
(847) 401-0182
Mailing address
1600 W LANE AVE UNIT 310, UPPER ARLINGTON, OH 43221-3966
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
30.024301
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/23/2014
Last updated
07/25/2023
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