Provider Demographics
NPI:1043297153
Name:JOHNSON, DWIGHT LAYNE (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:LAYNE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 S 2ND AVE STE D
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4100
Mailing Address - Country:US
Mailing Address - Phone:509-516-1200
Mailing Address - Fax:509-516-1209
Practice Address - Street 1:1129 S 2ND AVE STE D
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4100
Practice Address - Country:US
Practice Address - Phone:509-516-1200
Practice Address - Fax:509-516-1209
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-33821223P0300X
UT376097-99211223P0300X
WADE000109601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics