Provider Demographics
NPI:1639398597
Name:JAY A JOHNSON DDS LTD
Entity Type:Organization
Organization Name:JAY A JOHNSON DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:7023-962-2223
Mailing Address - Street 1:3220 N BRONCO ST
Mailing Address - Street 2:STE 102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4863
Mailing Address - Country:US
Mailing Address - Phone:702-396-2223
Mailing Address - Fax:702-396-7805
Practice Address - Street 1:3220 N BRONCO ST
Practice Address - Street 2:STE 102
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-4863
Practice Address - Country:US
Practice Address - Phone:702-396-2223
Practice Address - Fax:702-396-7805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2320122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty