Provider Demographics
NPI:1346903499
Name:JOHNSON ELITE SMILE GROUP, PLLC
Entity Type:Organization
Organization Name:JOHNSON ELITE SMILE GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:979-774-7500
Mailing Address - Street 1:3702 COPPERCREST DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5941
Mailing Address - Country:US
Mailing Address - Phone:979-774-7500
Mailing Address - Fax:
Practice Address - Street 1:8500 CYPRESSWOOD DR STE 204
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7109
Practice Address - Country:US
Practice Address - Phone:281-501-3001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNSON ELITE SMILES GROUP, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty