Provider Demographics
NPI:1689042228
Name:JOHNSON, CONRAD C (DMD MSD)
Entity Type:Individual
Prefix:
First Name:CONRAD
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DMD MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 W 120TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2802
Mailing Address - Country:US
Mailing Address - Phone:720-317-2660
Mailing Address - Fax:
Practice Address - Street 1:2741 W 120TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2802
Practice Address - Country:US
Practice Address - Phone:720-317-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2034841223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics