Provider Demographics
NPI:1972670511
Name:JOHNSON, ROBERT SHERMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SHERMAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:SHERMAN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS,MS
Mailing Address - Street 1:46 DARTMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3162
Mailing Address - Country:US
Mailing Address - Phone:760-770-1048
Mailing Address - Fax:760-324-3848
Practice Address - Street 1:46 DARTMOUTH DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3162
Practice Address - Country:US
Practice Address - Phone:760-770-1048
Practice Address - Fax:760-324-3848
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA187151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics