Provider Demographics
NPI:1275986010
Name:JOHNSON, TIMOTHY DWAIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DWAIN
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 1:18046 FM 529 RD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-1168
Mailing Address - Country:US
Mailing Address - Phone:832-593-0700
Mailing Address - Fax:
Practice Address - Street 1:18046 FM 529 RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-1168
Practice Address - Country:US
Practice Address - Phone:832-593-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-17
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice