Provider Demographics
NPI:1477664548
Name:BRIAN L JOHNSON DMD PC
Entity Type:Organization
Organization Name:BRIAN L JOHNSON DMD PC
Other - Org Name:A DENTAL TOUCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LAFE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-242-5112
Mailing Address - Street 1:7478 S CAMPUS VIEW DR
Mailing Address - Street 2:STE 200
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084
Mailing Address - Country:US
Mailing Address - Phone:801-242-5112
Mailing Address - Fax:801-242-5114
Practice Address - Street 1:7478 S CAMPUS VIEW DR
Practice Address - Street 2:STE 200
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084
Practice Address - Country:US
Practice Address - Phone:801-242-5112
Practice Address - Fax:801-242-5114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT373716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty