Provider Demographics
NPI:1730701822
Name:JOHNSON, AKENDRA S (DDS)
Entity type:Individual
Prefix:DR
First Name:AKENDRA
Middle Name:S
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 1:30 AUDREY LN
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1301
Mailing Address - Country:US
Mailing Address - Phone:301-567-5437
Mailing Address - Fax:
Practice Address - Street 1:30 AUDREY LN
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1301
Practice Address - Country:US
Practice Address - Phone:301-567-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD169281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice