Individual
MARTHA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1845 HOLSONBACK DR, DAYTONA BEACH, FL 32117-5114
(386) 624-3262
Mailing address
PO BOX 9190, DAYTONA BEACH, FL 32120-9190
(386) 247-0896
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
—
FL
124Q00000X
Dental Hygienist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
UNKNOWN
—
FL
Enumeration date
04/14/2020
Last updated
04/14/2020
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