Provider Demographics
NPI:1538886759
Name:JOHNSON, LISA BENNETT (RDH)
Entity type:Individual
Prefix:PROF
First Name:LISA
Middle Name:BENNETT
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:166 WHITNEY ST
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-1446
Mailing Address - Country:US
Mailing Address - Phone:774-364-2951
Mailing Address - Fax:
Practice Address - Street 1:166 WHITNEY ST
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1446
Practice Address - Country:US
Practice Address - Phone:774-364-2951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist