Provider Demographics
NPI:1730265273
Name:JOHNSON, ALESIA (DMD)
Entity type:Individual
Prefix:DR
First Name:ALESIA
Middle Name:
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 1:526 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08102-1211
Mailing Address - Country:US
Mailing Address - Phone:856-541-9797
Mailing Address - Fax:856-547-0797
Practice Address - Street 1:526 COOPER ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102-1211
Practice Address - Country:US
Practice Address - Phone:856-541-9797
Practice Address - Fax:856-547-0797
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0263041223G0001X
NJ22DI020738001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice