Provider Demographics
NPI:1497858039
Name:JOHNSON, JAMES L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
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 1:8813 SOUTH REDWOOD ROAD
Mailing Address - Street 2:STE C
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088
Mailing Address - Country:US
Mailing Address - Phone:801-255-7800
Mailing Address - Fax:801-566-8379
Practice Address - Street 1:8813 SOUTH REDWOOD ROAD
Practice Address - Street 2:STE C
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088
Practice Address - Country:US
Practice Address - Phone:801-255-7800
Practice Address - Fax:801-566-8379
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14024799221223G0001X
UT14024789031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice