Provider Demographics
NPI:1093920589
Name:JOHNSON, JAMES VERNON (DDS,MS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:VERNON
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UTHSC HOUSTON DBB 6516 MD ANDERSON BLVD
Mailing Address - Street 2:DEPT OMFS 2.059
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3402
Mailing Address - Country:US
Mailing Address - Phone:713-500-4125
Mailing Address - Fax:713-500-4333
Practice Address - Street 1:6516 JOHN FREEMAN ST
Practice Address - Street 2:DEPT OMFS 2.059
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3402
Practice Address - Country:US
Practice Address - Phone:713-500-4125
Practice Address - Fax:713-500-4333
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery