Provider Demographics
NPI:1023024064
Name:JOHNSON, RICHARD S (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:M
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:SOUTH VALLEY FAMILY DENTAL DR. RICHARD S. JOHNSON DDS
Mailing Address - Street 2:271 N. SPRINGCREEK PKWY SUITE D
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9875
Mailing Address - Country:US
Mailing Address - Phone:435-787-2122
Mailing Address - Fax:435-755-6797
Practice Address - Street 1:SOUTH VALLEY FAMILY DENTAL DR. RICHARD S. JOHNSON DDS
Practice Address - Street 2:271 N. SPRINGCREEK PKWY SUITE D
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9875
Practice Address - Country:US
Practice Address - Phone:435-787-2122
Practice Address - Fax:435-755-6797
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT59090981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT202830421OtherTAX I.D. #
UT5909098OtherSTATE OF UTAH LICENSE
UTBJ9309267OtherDEA #