Provider Demographics
NPI:1447474168
Name:JOHNSON, FELIX JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:FELIX
Middle Name:JOSEPH
Last Name:JOHNSON
Suffix:
Gender:M
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:PO BOX 642
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:KY
Mailing Address - Zip Code:40444-0642
Mailing Address - Country:US
Mailing Address - Phone:859-792-4236
Mailing Address - Fax:859-792-6033
Practice Address - Street 1:1183 STANFORD RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:KY
Practice Address - Zip Code:40444
Practice Address - Country:US
Practice Address - Phone:859-792-4236
Practice Address - Fax:859-792-6033
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice