Provider Demographics
NPI:1003920364
Name:JOHN L JOHNSON DDS AND TODD L JOHNSON DDS INC
Entity type:Organization
Organization Name:JOHN L JOHNSON DDS AND TODD L JOHNSON DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-967-1199
Mailing Address - Street 1:10425 FAIR OAKS BLVD
Mailing Address - Street 2:SUITE #202
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628
Mailing Address - Country:US
Mailing Address - Phone:916-967-1199
Mailing Address - Fax:916-967-1239
Practice Address - Street 1:10425 FAIR OAKS BLVD
Practice Address - Street 2:SUITE #202
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628
Practice Address - Country:US
Practice Address - Phone:916-967-1199
Practice Address - Fax:916-967-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA202091223G0001X
CA466161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty