Provider Demographics
NPI:1295229722
Name:JOHNSON, DANIEL DARIUS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DARIUS
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 1:7707 VALERA LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5138
Mailing Address - Country:US
Mailing Address - Phone:832-483-5762
Mailing Address - Fax:
Practice Address - Street 1:6109 E HIGHWAY 191
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-5348
Practice Address - Country:US
Practice Address - Phone:432-305-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty