Provider Demographics
NPI:1265038376
Name:JEFFREY M. JOHNSON, DDS, PLLC
Entity Type:Organization
Organization Name:JEFFREY M. JOHNSON, DDS, PLLC
Other - Org Name:JORDAN VIEW DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-255-8030
Mailing Address - Street 1:9103 S 1300 W STE 104
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-6708
Mailing Address - Country:US
Mailing Address - Phone:801-255-8030
Mailing Address - Fax:
Practice Address - Street 1:9103 S 1300 W STE 104
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-6708
Practice Address - Country:US
Practice Address - Phone:801-255-8030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-05
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental