Provider Demographics
NPI:1821355298
Name:JOHNSON DENTAL CORPORATION
Entity Type:Organization
Organization Name:JOHNSON DENTAL CORPORATION
Other - Org Name:LA CUMBRE DENTAL SPECIALTY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JULIA
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:805-682-4800
Mailing Address - Street 1:200 N LA CUMBRE RD
Mailing Address - Street 2:STE H
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1577
Mailing Address - Country:US
Mailing Address - Phone:805-960-5600
Mailing Address - Fax:805-682-8899
Practice Address - Street 1:200 N LA CUMBRE RD
Practice Address - Street 2:STE H
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1577
Practice Address - Country:US
Practice Address - Phone:805-960-5600
Practice Address - Fax:805-682-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530461223E0200X
1223G0001X
CA609461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty