Provider Demographics
NPI:1912194242
Name:JOHNSON FAMILY DENTAL OFFICE INC.
Entity Type:Organization
Organization Name:JOHNSON FAMILY DENTAL OFFICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-643-5026
Mailing Address - Street 1:88 N OAK ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-5686
Mailing Address - Country:US
Mailing Address - Phone:805-643-5026
Mailing Address - Fax:805-643-5029
Practice Address - Street 1:88 N OAK ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-5686
Practice Address - Country:US
Practice Address - Phone:805-643-5026
Practice Address - Fax:805-643-5029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty