| NPI | 1780759241 |
|---|---|
| Professional Name | MANDY LYNN MATTERN JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS036258) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS036258) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2018-04-11 |