Provider Demographics
NPI:1205044369
Name:JOHNSON, CARL JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:JOSEPH
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 1:7241 OWENSMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1530
Mailing Address - Country:US
Mailing Address - Phone:818-346-3040
Mailing Address - Fax:818-346-3084
Practice Address - Street 1:7241 OWENSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1530
Practice Address - Country:US
Practice Address - Phone:818-346-3040
Practice Address - Fax:818-346-3084
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice