Provider Demographics
NPI:1134343411
Name:JOHNSON, ROBERT HENRY (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:HENRY
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 1:105 SOUTH PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801
Mailing Address - Country:US
Mailing Address - Phone:325-646-7823
Mailing Address - Fax:325-646-4540
Practice Address - Street 1:105 S PARK DR
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5917
Practice Address - Country:US
Practice Address - Phone:325-646-7823
Practice Address - Fax:325-646-4540
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6219122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist