Provider Demographics
NPI:1174976849
Name:JOHNSON, BRIANNA THERESA (DMD)
Entity type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:THERESA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:THERESA
Other - Last Name:LOCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 JASONS WAY
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003
Mailing Address - Country:US
Mailing Address - Phone:717-867-5088
Mailing Address - Fax:
Practice Address - Street 1:1 JASONS WAY
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:PA
Practice Address - Zip Code:17003
Practice Address - Country:US
Practice Address - Phone:717-867-5088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.8768 GD1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice