Provider Demographics
NPI:1215003751
Name:JOHNSON, RICKY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:LYNN
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 1:403 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7407
Mailing Address - Country:US
Mailing Address - Phone:501-268-7151
Mailing Address - Fax:501-268-7103
Practice Address - Street 1:403 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7407
Practice Address - Country:US
Practice Address - Phone:501-268-7151
Practice Address - Fax:501-268-7103
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR21601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice