Provider Demographics
NPI: | 1922527209 |
---|---|
Name: | STEVEN G. JOHNSON DENTAL CORPORATION |
Entity Type: | Organization |
Organization Name: | STEVEN G. JOHNSON DENTAL CORPORATION |
Other - Org Name: | JOHNSON FAMILY DENTAL |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OPERATIONS SUPPORT MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | AMY |
Authorized Official - Middle Name: | LOUISE |
Authorized Official - Last Name: | BUTTERY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 805-456-1235 |
Mailing Address - Street 1: | 305 E PORT HUENEME RD |
Mailing Address - Street 2: | |
Mailing Address - City: | PORT HUENEME |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 93041-3222 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 805-488-1112 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 305 E PORT HUENEME RD |
Practice Address - Street 2: | |
Practice Address - City: | PORT HUENEME |
Practice Address - State: | CA |
Practice Address - Zip Code: | 93041-3222 |
Practice Address - Country: | US |
Practice Address - Phone: | 805-488-1112 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-09-18 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Multi-Specialty |