Provider Demographics
NPI:1063865269
Name:TODD S. JOHNSON, DDS, PS
Entity Type:Organization
Organization Name:TODD S. JOHNSON, DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-533-7120
Mailing Address - Street 1:501 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-6013
Mailing Address - Country:US
Mailing Address - Phone:360-533-7120
Mailing Address - Fax:360-532-1250
Practice Address - Street 1:501 W MARKET ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6013
Practice Address - Country:US
Practice Address - Phone:360-533-7120
Practice Address - Fax:360-532-1250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00010278122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1154416881OtherINDIVIDUAL NPI