Provider Demographics
NPI:1588817001
Name:JOHNSON, DOUGLAS B (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:B
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 1:9176 I AVE
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-6526
Mailing Address - Country:US
Mailing Address - Phone:760-244-2027
Mailing Address - Fax:760-244-0361
Practice Address - Street 1:9176 I AVE
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-6526
Practice Address - Country:US
Practice Address - Phone:760-244-2027
Practice Address - Fax:760-244-0361
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41427122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist