Provider Demographics
NPI:1538232269
Name:JOHNNY JOHNSON JR & ALEX J JOHNSON, PA
Entity type:Organization
Organization Name:JOHNNY JOHNSON JR & ALEX J JOHNSON, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING BOOKKEEPING
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRISH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-786-7551
Mailing Address - Street 1:3840 TAMPA RD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3600
Mailing Address - Country:US
Mailing Address - Phone:727-786-7551
Mailing Address - Fax:
Practice Address - Street 1:3840 TAMPA RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3600
Practice Address - Country:US
Practice Address - Phone:727-786-7551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN96431223P0221X
FLDN96401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty