Provider Demographics
NPI:1366800948
Name:JOHNSON, MADALYN (DDS)
Entity type:Individual
Prefix:
First Name:MADALYN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 AIPUNI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1801
Mailing Address - Country:US
Mailing Address - Phone:417-529-6406
Mailing Address - Fax:
Practice Address - Street 1:1257 KILAUEA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4205
Practice Address - Country:US
Practice Address - Phone:808-333-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program