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?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty