Provider Demographics
NPI:1619652146
Name:JOHNSON, HANNAH C (DMD)
Entity type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:C
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 1:2512 KENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-4326
Mailing Address - Country:US
Mailing Address - Phone:832-628-5339
Mailing Address - Fax:
Practice Address - Street 1:300 BILLINGSLEY RD STE 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3092
Practice Address - Country:US
Practice Address - Phone:832-628-5339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13291122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist