Provider Demographics
NPI:1356533822
Name:JOHNSON, MATTHEW BEN (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BEN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:119 CIMARRON PARK LOOP
Mailing Address - Street 2:C
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2839
Mailing Address - Country:US
Mailing Address - Phone:512-295-7600
Mailing Address - Fax:512-295-7633
Practice Address - Street 1:119 CIMARRON PARK LOOP
Practice Address - Street 2:C
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-2839
Practice Address - Country:US
Practice Address - Phone:512-295-7600
Practice Address - Fax:512-295-7633
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX224811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry