Provider Demographics
NPI:1861510927
Name:JOHNSON, DALYN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:DALYN
Middle Name:J
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:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:TX
Mailing Address - Zip Code:76837-0246
Mailing Address - Country:US
Mailing Address - Phone:325-869-8471
Mailing Address - Fax:325-869-5522
Practice Address - Street 1:212 JACKSON ST.
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:TX
Practice Address - Zip Code:76837-0246
Practice Address - Country:US
Practice Address - Phone:325-869-8471
Practice Address - Fax:325-869-5522
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice