Provider Demographics
NPI:1548953235
Name:JOHNSON, PARKER THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:PARKER
Middle Name:THOMAS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 CEDAR ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2439
Mailing Address - Country:US
Mailing Address - Phone:518-306-8660
Mailing Address - Fax:
Practice Address - Street 1:9 DIGITAL WAY STE 4
Practice Address - Street 2:
Practice Address - City:MAYNARD
Practice Address - State:MA
Practice Address - Zip Code:01754-2353
Practice Address - Country:US
Practice Address - Phone:978-897-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN10000309122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist