Provider Demographics
NPI:1417477019
Name:EDWARDS, JOHNSON & JOHNSON
Entity Type:Organization
Organization Name:EDWARDS, JOHNSON & JOHNSON
Other - Org Name:PACIFIC NORTHWEST ORAL & MAXILLOFACIAL SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-277-1844
Mailing Address - Street 1:1900 S PUGET DR
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-4421
Mailing Address - Country:US
Mailing Address - Phone:425-228-1521
Mailing Address - Fax:
Practice Address - Street 1:1900 S PUGET DR
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-4421
Practice Address - Country:US
Practice Address - Phone:425-228-1521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDWARDS & JOHNSON D.D.S., P.L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1223G0001X
WADE602045501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty