Provider Demographics
NPI:1518343177
Name:JOHNSON, LEON AJAYI (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:AJAYI
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 1:91-919 FORT WEAVER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2257
Mailing Address - Country:US
Mailing Address - Phone:808-308-9720
Mailing Address - Fax:
Practice Address - Street 1:91-919 FORT WEAVER RD STE 105
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2257
Practice Address - Country:US
Practice Address - Phone:808-308-9720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT26511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice