Provider Demographics
NPI:1972007342
Name:JOHNSON, TADARROL ANDREW (DDS)
Entity Type:Individual
Prefix:
First Name:TADARROL
Middle Name:ANDREW
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 1:860 S TRUMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-3713
Mailing Address - Country:US
Mailing Address - Phone:636-937-6965
Mailing Address - Fax:636-937-8607
Practice Address - Street 1:860 S TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-3713
Practice Address - Country:US
Practice Address - Phone:636-937-6965
Practice Address - Fax:636-937-8607
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018007650122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist