Provider Demographics
NPI:1881707420
Name:JOHANNES, ERICA M (DDS)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:M
Last Name:JOHANNES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MALLARD LAKES CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9300
Mailing Address - Country:US
Mailing Address - Phone:920-254-9865
Mailing Address - Fax:
Practice Address - Street 1:3020 SUNSET BLVD STE 106
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3494
Practice Address - Country:US
Practice Address - Phone:803-233-1980
Practice Address - Fax:803-602-6397
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4571122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty