Provider Demographics
NPI:1588624431
Name:JOHNSON, DAWN DENISE (MD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:DENISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 N STEMMONS FWY STE F2400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-2700
Mailing Address - Country:US
Mailing Address - Phone:469-488-7100
Mailing Address - Fax:469-488-7101
Practice Address - Street 1:2350 N STEMMONS FWY STE F2400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207-2700
Practice Address - Country:US
Practice Address - Phone:469-488-7100
Practice Address - Fax:469-488-7101
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4989208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158269401Medicaid
TX8A6849Medicare ID - Type Unspecified