Provider Demographics
NPI:1467661967
Name:JOHNSON AND ASSOCIATES DDS PC
Entity Type:Organization
Organization Name:JOHNSON AND ASSOCIATES DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:O
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-392-4201
Mailing Address - Street 1:200 PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-2504
Mailing Address - Country:US
Mailing Address - Phone:719-392-4201
Mailing Address - Fax:719-391-7873
Practice Address - Street 1:200 PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-2504
Practice Address - Country:US
Practice Address - Phone:719-392-4201
Practice Address - Fax:719-391-7873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty