Provider Demographics
NPI:1164639167
Name:JOHNSON, DANIEL P (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:P
Last Name:JOHNSON
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Gender:M
Credentials:DDS, PC
Other - Prefix:
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Mailing Address - Street 1:630 15TH AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2700
Mailing Address - Country:US
Mailing Address - Phone:303-485-0300
Mailing Address - Fax:303-485-0777
Practice Address - Street 1:630 15TH AVE
Practice Address - Street 2:STE 101
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2700
Practice Address - Country:US
Practice Address - Phone:303-485-0300
Practice Address - Fax:303-485-0777
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO77781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery