Provider Demographics
NPI:1467492793
Name:PERSONS, JOHN WILLIAMS (DDS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WILLIAMS
Last Name:PERSONS
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 1:2438 N PONDEROSA DR
Mailing Address - Street 2:#C217
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2369
Mailing Address - Country:US
Mailing Address - Phone:805-484-1611
Mailing Address - Fax:805-482-1069
Practice Address - Street 1:2438 N PONDEROSA DR
Practice Address - Street 2:#C217
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2369
Practice Address - Country:US
Practice Address - Phone:805-484-1611
Practice Address - Fax:805-482-1069
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD199521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD19952OtherDENTIST