Provider Demographics
NPI:1164595187
Name:JOHNSON, JOHNNY JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 WATERFORD CIR E
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-7206
Mailing Address - Country:US
Mailing Address - Phone:727-938-9322
Mailing Address - Fax:
Practice Address - Street 1:3840 TAMPA RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3600
Practice Address - Country:US
Practice Address - Phone:727-786-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN96431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry