SHANNON P JOHNSON DMD PLLC NPI 1316579279

NPI Information

NPI: 1316579279
Provider Name: SHANNON P JOHNSON DMD PLLC
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

CLIA Number: 18D2247850

Address:
9510 ORMSBY STATION RD STE 203
LOUISVILLE, KY
ZIP 40223
Phone: (502) 805-0500
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SHANNON P JOHNSON DMD PLLC is a dental clinic center in Louisville, KY. SHANNON P JOHNSON DMD PLLC NPI is 1316579279. The provider is registered as an organization entity type.

The provider's business location address is:

9510 ORMSBY STATION RD STE 203
LOUISVILLE, KY
ZIP 40223-083
Phone: (502) 805-0500
Fax: (502) 771-6041

The provider's authorized official is Shannon Polly Johnson .
The authorized official title is President and has the following contact phone number (502) 957-9390.

The CLIA number assigned to this NPI record is 18D2247850 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/9/2020 and was last updated on 2/8/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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