Provider Demographics
NPI:1528553773
Name:JOHNSON, NATHAN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:M
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 1:11187 SHERIDAN BLVD UNIT 12
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-3230
Mailing Address - Country:US
Mailing Address - Phone:303-469-2333
Mailing Address - Fax:303-469-2011
Practice Address - Street 1:11187 SHERIDAN BLVD UNIT 12
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80020-3230
Practice Address - Country:US
Practice Address - Phone:303-469-2333
Practice Address - Fax:303-469-2011
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2036611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice