Provider Demographics
NPI:1114040011
Name:JOHNSON, BRUCE HINTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:HINTON
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 1:7641 SHAFFER PKWY
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-3013
Mailing Address - Country:US
Mailing Address - Phone:303-989-0577
Mailing Address - Fax:303-989-0937
Practice Address - Street 1:7641 SHAFFER PKWY
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-3013
Practice Address - Country:US
Practice Address - Phone:303-989-0577
Practice Address - Fax:303-989-0937
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO73781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice