Provider Demographics
NPI:1407177561
Name:JOHNSON, STEVEN WILLIAM (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:WILLIAM
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 1:6551 MINNEWAUKAN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-2405
Mailing Address - Country:US
Mailing Address - Phone:720-273-9176
Mailing Address - Fax:
Practice Address - Street 1:275 CENTURY CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9729
Practice Address - Country:US
Practice Address - Phone:303-666-4499
Practice Address - Fax:303-666-2119
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.024187122300000X
CO106561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes122300000XDental ProvidersDentist