Provider Demographics
NPI:1043420797
Name:JOHNSON, ROY H (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:H
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 1:997 WINDY HILL RD SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2045
Mailing Address - Country:US
Mailing Address - Phone:770-405-8707
Mailing Address - Fax:770-405-8709
Practice Address - Street 1:997 WINDY HILL RD. SE
Practice Address - Street 2:SUITE C
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080
Practice Address - Country:US
Practice Address - Phone:770-405-8707
Practice Address - Fax:770-405-8709
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA80431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice