Provider Demographics
NPI:1679058135
Name:JOHNSON, PATRICIA A (RDH)
Entity type:Individual
Prefix:PROF
First Name:PATRICIA
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 SCOTT SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-3324
Mailing Address - Country:US
Mailing Address - Phone:860-773-1679
Mailing Address - Fax:
Practice Address - Street 1:271 SCOTT SWAMP RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-3324
Practice Address - Country:US
Practice Address - Phone:860-773-1679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005030124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist