Provider Demographics
NPI:1891398665
Name:JOHNSON, BARRY LAYLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:LAYLE
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 1:2954 E SCENIC VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4952
Mailing Address - Country:US
Mailing Address - Phone:801-599-1908
Mailing Address - Fax:
Practice Address - Street 1:2954 E SCENIC VALLEY LN
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-4952
Practice Address - Country:US
Practice Address - Phone:801-599-1908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT143772-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice