Provider Demographics
NPI:1548447519
Name:JOHNSON, ARCHANA MANOHAR (DDS)
Entity type:Individual
Prefix:DR
First Name:ARCHANA
Middle Name:MANOHAR
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17904 GEORGIA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2239
Mailing Address - Country:US
Mailing Address - Phone:301-963-1900
Mailing Address - Fax:301-963-1901
Practice Address - Street 1:17904 GEORGIA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2239
Practice Address - Country:US
Practice Address - Phone:301-963-1900
Practice Address - Fax:301-963-1901
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist