Provider Demographics
NPI:1164540142
Name:JOHNSON, PHILLIP H (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:H
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 1:8000 COIT RD
Mailing Address - Street 2:STE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-6820
Mailing Address - Country:US
Mailing Address - Phone:972-335-5455
Mailing Address - Fax:972-335-2040
Practice Address - Street 1:8000 COIT RD STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-6820
Practice Address - Country:US
Practice Address - Phone:972-335-5455
Practice Address - Fax:972-335-2040
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX18128OtherLICENSE