Provider Demographics
NPI:1093936791
Name:JOHNSON-ANDERSON ENDODONTICS
Entity Type:Organization
Organization Name:JOHNSON-ANDERSON ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:918-523-5080
Mailing Address - Street 1:7134 S YALE AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6372
Mailing Address - Country:US
Mailing Address - Phone:918-523-5080
Mailing Address - Fax:
Practice Address - Street 1:7134 S YALE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6372
Practice Address - Country:US
Practice Address - Phone:918-523-5080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental