Provider Demographics
NPI:1710141023
Name:JOHNSON, BRIAN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MICHAEL
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 1:1628 CRABB RIVER RD
Mailing Address - Street 2:STE B
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5634
Mailing Address - Country:US
Mailing Address - Phone:281-937-1671
Mailing Address - Fax:281-545-2572
Practice Address - Street 1:1628 CRABB RIVER RD
Practice Address - Street 2:STE B
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-5634
Practice Address - Country:US
Practice Address - Phone:281-937-1671
Practice Address - Fax:281-545-2572
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist