Provider Demographics
NPI:1033399100
Name:JOHNSON, DANA MICHELE (DMD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:MICHELE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 HIGHWAY 11W STE E
Mailing Address - Street 2:
Mailing Address - City:BEAN STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37708-5810
Mailing Address - Country:US
Mailing Address - Phone:865-993-2225
Mailing Address - Fax:865-993-2225
Practice Address - Street 1:1277 HIGHWAY 11W STE E
Practice Address - Street 2:
Practice Address - City:BEAN STATION
Practice Address - State:TN
Practice Address - Zip Code:37708-5810
Practice Address - Country:US
Practice Address - Phone:865-993-2225
Practice Address - Fax:865-993-2225
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS92081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice