Provider Demographics
NPI:1346210168
Name:JOHNSON, JEFFREY ROLAND (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ROLAND
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7134 S YALE AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6372
Mailing Address - Country:US
Mailing Address - Phone:918-523-5080
Mailing Address - Fax:918-523-5081
Practice Address - Street 1:7134 S YALE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6372
Practice Address - Country:US
Practice Address - Phone:918-523-5080
Practice Address - Fax:918-523-5081
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37091223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics