Provider Demographics
NPI:1174973010
Name:HENAO ROJAS, JOHANA ANDREA (DMD)
Entity type:Individual
Prefix:
First Name:JOHANA
Middle Name:ANDREA
Last Name:HENAO ROJAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 HARMONY RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-1436
Mailing Address - Country:US
Mailing Address - Phone:215-908-2232
Mailing Address - Fax:
Practice Address - Street 1:1135 E CHOCOLATE AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1220
Practice Address - Country:US
Practice Address - Phone:717-534-1135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040826122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice