Provider Demographics
NPI:1417481532
Name:CHARLES E JOHNSON DDS
Entity Type:Organization
Organization Name:CHARLES E JOHNSON DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:I
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-797-3867
Mailing Address - Street 1:5401 S PRINCE ST
Mailing Address - Street 2:101
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-1153
Mailing Address - Country:US
Mailing Address - Phone:303-797-3867
Mailing Address - Fax:303-794-4535
Practice Address - Street 1:5401 S PRINCE ST
Practice Address - Street 2:101
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-1153
Practice Address - Country:US
Practice Address - Phone:303-797-3867
Practice Address - Fax:303-794-4535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHD104327122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty