Provider Demographics
NPI:1861708927
Name:JOHNSON, JONATHAN CHAPIN (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CHAPIN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
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Mailing Address - Street 1:18947 JOHN J WILLIAMS HWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-4474
Mailing Address - Country:US
Mailing Address - Phone:302-645-5554
Mailing Address - Fax:302-645-5546
Practice Address - Street 1:18947 JOHN J WILLIAMS HWY
Practice Address - Street 2:SUITE 310
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-4474
Practice Address - Country:US
Practice Address - Phone:302-645-5554
Practice Address - Fax:302-645-5546
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00012491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics