Provider Demographics
NPI:1710008594
Name:J S JOHNESSEE, D.D.S. PC
Entity type:Organization
Organization Name:J S JOHNESSEE, D.D.S. PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SHREVE
Authorized Official - Last Name:JOHNESSEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:717-747-0115
Mailing Address - Street 1:85 WYNTRE BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4536
Mailing Address - Country:US
Mailing Address - Phone:717-747-0115
Mailing Address - Fax:717-741-5026
Practice Address - Street 1:85 WYNTRE BROOKE DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4536
Practice Address - Country:US
Practice Address - Phone:717-747-0115
Practice Address - Fax:717-741-5026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO17652L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty