Provider Demographics
NPI:1104394931
Name:JOHNSON DENTAL PARTNERS
Entity Type:Organization
Organization Name:JOHNSON DENTAL PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-399-4000
Mailing Address - Street 1:75 W CALLE DE LAS TIENDAS STE 125B
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-4237
Mailing Address - Country:US
Mailing Address - Phone:520-399-4000
Mailing Address - Fax:520-399-4003
Practice Address - Street 1:75 W CALLE DE LAS TIENDAS STE 125B
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-4237
Practice Address - Country:US
Practice Address - Phone:520-399-4000
Practice Address - Fax:520-399-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherDENTAL