Provider Demographics
NPI:1851398226
Name:JOHNSON, DAVID M (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
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 1:620 SOUTHPOINTE CT
Mailing Address - Street 2:STE 210
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3885
Mailing Address - Country:US
Mailing Address - Phone:719-527-9098
Mailing Address - Fax:719-527-3395
Practice Address - Street 1:620 SOUTHPOINTE CT
Practice Address - Street 2:STE 210
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3885
Practice Address - Country:US
Practice Address - Phone:719-527-9098
Practice Address - Fax:719-527-3395
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice