Provider Demographics
NPI:1467646240
Name:JOHNSON, ROBERT CARL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CARL
Last Name:JOHNSON
Suffix:JR
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 1:7260 WEST BLVD
Mailing Address - Street 2:BLDG. G
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-7334
Mailing Address - Country:US
Mailing Address - Phone:330-758-8388
Mailing Address - Fax:330-758-6733
Practice Address - Street 1:7260 WEST BLVD
Practice Address - Street 2:BLDG. G
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-7334
Practice Address - Country:US
Practice Address - Phone:330-758-8388
Practice Address - Fax:330-758-6733
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-016433122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist