Provider Demographics
NPI:1457568602
Name:JOHNSON, RANDALL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:J
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 1:7600 E CAMELBACK RD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-2106
Mailing Address - Country:US
Mailing Address - Phone:480-947-7477
Mailing Address - Fax:480-941-3760
Practice Address - Street 1:7600 E CAMELBACK RD
Practice Address - Street 2:SUITE #4
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-2106
Practice Address - Country:US
Practice Address - Phone:480-947-7477
Practice Address - Fax:480-941-3760
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ36281223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics