Provider Demographics
NPI:1235527557
Name:PAUL A. JOHNSON DDS INC
Entity Type:Organization
Organization Name:PAUL A. JOHNSON DDS INC
Other - Org Name:PEDIATRIC DENTISTRY OF WEST SACRAMENTO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-277-8055
Mailing Address - Street 1:2101 STONE BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-4044
Mailing Address - Country:US
Mailing Address - Phone:916-227-8055
Mailing Address - Fax:916-266-7513
Practice Address - Street 1:2101 STONE BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-4044
Practice Address - Country:US
Practice Address - Phone:916-227-8055
Practice Address - Fax:916-266-7513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA578091223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty