Individual
DR. JAY WILSON JOHNSON I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
BLDG H 2005 KNIGHT LANE, NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SVCS, JACKSONVILLE, FL 32212-0140
(760) 725-5102
Mailing address
PO BOX 555221, CAMP PENDLETON, CA 92055-5221
(760) 725-5102
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12007800A
IN
Other
Enumeration date
12/14/2005
Last updated
02/03/2009
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