Provider Demographics
NPI:1861565947
Name:JOHNSON, ELBERT L (DDS, MPH, PA)
Entity type:Individual
Prefix:
First Name:ELBERT
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS, MPH, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 E ASH ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-0187
Mailing Address - Country:US
Mailing Address - Phone:919-734-3505
Mailing Address - Fax:919-735-1020
Practice Address - Street 1:804 E ASH ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-0187
Practice Address - Country:US
Practice Address - Phone:919-734-3505
Practice Address - Fax:919-735-1020
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC44961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice