Provider Demographics
NPI:1376977702
Name:JOHNSON, WILLIAM JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JAMES
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 1:140 HIDDEN VALLEY PKWY
Mailing Address - Street 2:SUITE K
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-4000
Mailing Address - Country:US
Mailing Address - Phone:951-898-8673
Mailing Address - Fax:951-898-1147
Practice Address - Street 1:140 HIDDEN VALLEY PKWY
Practice Address - Street 2:SUITE K
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-4000
Practice Address - Country:US
Practice Address - Phone:951-898-8673
Practice Address - Fax:951-898-1147
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA621361223G0001X
UT8513664-99221223G0001X
UT8513664-89031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice