Provider Demographics
NPI:1518198480
Name:JOHNSON-HARRISON, DAVETTE D (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVETTE
Middle Name:D
Last Name:JOHNSON-HARRISON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAVETTE
Other - Middle Name:D
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:13331 JONES RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070
Mailing Address - Country:US
Mailing Address - Phone:832-559-7125
Mailing Address - Fax:832-843-6173
Practice Address - Street 1:13331 JONES RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070
Practice Address - Country:US
Practice Address - Phone:832-559-7125
Practice Address - Fax:832-843-6173
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248331223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216352905Medicaid