Provider Demographics
NPI:1871896845
Name:JOHNSON, PAMELA J (DDS)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:545 PLAINFIELD RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7600
Mailing Address - Country:US
Mailing Address - Phone:630-887-1188
Mailing Address - Fax:630-887-1968
Practice Address - Street 1:545 PLAINFIELD RD
Practice Address - Street 2:SUITE D
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7600
Practice Address - Country:US
Practice Address - Phone:630-887-1188
Practice Address - Fax:630-887-1968
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210015891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics