Provider Demographics
NPI:1821091513
Name:JOHNSON, CLIFTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:
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 1:1223 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2503
Mailing Address - Country:US
Mailing Address - Phone:706-571-9320
Mailing Address - Fax:
Practice Address - Street 1:1223 3RD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2503
Practice Address - Country:US
Practice Address - Phone:706-571-9320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2016-08-24
Deactivation Date:2006-03-31
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
GA102601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice