Individual
DR. GRADY EARL JOHNSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4273 POINT LA VISTA RD S, JACKSONVILLE, FL 32207-6243
(904) 398-0404
(904) 398-0404
Mailing address
4273 POINT LA VISTA RD S, JACKSONVILLE, FL 32207-6243
(904) 398-0404
(904) 398-0404
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN 7137
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
074459000
—
FL
Enumeration date
08/22/2006
Last updated
03/07/2023
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