Provider Demographics
NPI:1497763270
Name:JOHNSON, RODNEY W (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:W
Last Name:JOHNSON
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 1:1126 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-6371
Mailing Address - Country:US
Mailing Address - Phone:361-937-2316
Mailing Address - Fax:270-897-1758
Practice Address - Street 1:1126 S 14TH ST
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-6371
Practice Address - Country:US
Practice Address - Phone:361-937-2316
Practice Address - Fax:270-897-1758
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist