Provider Demographics
NPI:1508296005
Name:JOHNSON, ANDREW C (DDS, MDS, CDT)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS, MDS, CDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 S PINNACLE HILLS PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8953
Mailing Address - Country:US
Mailing Address - Phone:479-755-3000
Mailing Address - Fax:
Practice Address - Street 1:3333 S PINNACLE HILLS PKWY STE 140
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8953
Practice Address - Country:US
Practice Address - Phone:479-755-3000
Practice Address - Fax:479-616-1914
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR39601223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics