Provider Demographics
NPI:1760126965
Name:J.O. JOHNSON DDS
Entity Type:Organization
Organization Name:J.O. JOHNSON DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:660-232-9123
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-0027
Mailing Address - Country:US
Mailing Address - Phone:660-232-9123
Mailing Address - Fax:
Practice Address - Street 1:611 S BUSINESS HIGHWAY 13
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1511
Practice Address - Country:US
Practice Address - Phone:660-232-9123
Practice Address - Fax:660-259-2321
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J.O. JOHNSON DDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental