Organization
FISHHAWK FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARC ROY JOHNSON DMD (PARTNER)
(813) 662-7171
Entity
Organization
Contact information
Practice address
16737 FISHHAWK BLVD, LITHIA, FL 33547-3860
(813) 662-7171
(813) 662-3024
Mailing address
16737 FISHHAWK BLVD, LITHIA, FL 33547-3860
(813) 662-7171
(813) 662-3024
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DN15183
FL
1223G0001X
General Practice Dentistry
Primary
DN16752
FL
1223G0001X
General Practice Dentistry
DN17531
FL
Other
Enumeration date
05/08/2007
Last updated
08/02/2007
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