Provider Demographics
NPI:1922399740
Name:JOHNSON, STEVEN DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DANIEL
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 1:1635 N GEORGE MASON DR STE 160
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3680
Mailing Address - Country:US
Mailing Address - Phone:703-522-3363
Mailing Address - Fax:703-522-3370
Practice Address - Street 1:1635 N GEORGE MASON DR STE 160
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3680
Practice Address - Country:US
Practice Address - Phone:703-522-3363
Practice Address - Fax:703-522-3370
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010065821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice