Provider Demographics
NPI:1609033141
Name:NANTZ, JOHNNY LEWIS JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:LEWIS
Last Name:NANTZ
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3901 S LAMAR BLVD STE 420
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7990
Mailing Address - Country:US
Mailing Address - Phone:512-445-3355
Mailing Address - Fax:
Practice Address - Street 1:3901 S LAMAR BLVD STE 420
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7990
Practice Address - Country:US
Practice Address - Phone:512-445-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV50691223X0400X
TX223281223X0400X
FL180811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics