Provider Demographics
NPI:1437135001
Name:JOHNSON, ROBERT VINCENT (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:VINCENT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 WEST LAKE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-5801
Mailing Address - Country:US
Mailing Address - Phone:847-729-6300
Mailing Address - Fax:847-729-6331
Practice Address - Street 1:3633 W LAKE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5805
Practice Address - Country:US
Practice Address - Phone:847-729-6300
Practice Address - Fax:847-729-6331
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A160141223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry