Provider Demographics
NPI:1245220383
Name:JOHNSON, RICHARD E (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
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 1:6944 A ST
Mailing Address - Street 2:STE B
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4112
Mailing Address - Country:US
Mailing Address - Phone:402-483-7597
Mailing Address - Fax:402-483-7598
Practice Address - Street 1:6944 A ST
Practice Address - Street 2:STE B
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4112
Practice Address - Country:US
Practice Address - Phone:402-483-7597
Practice Address - Fax:402-483-7598
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE43031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
412515OtherUNIKD CONCORDIA
5316OtherBCBS