Provider Demographics
NPI:1457580342
Name:JOHNSON, TALIAH J ((DDS))
Entity Type:Individual
Prefix:
First Name:TALIAH
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:(DDS)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 SCOTT ST STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-2698
Mailing Address - Country:US
Mailing Address - Phone:713-741-1000
Mailing Address - Fax:
Practice Address - Street 1:6120 SCOTT ST STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-2698
Practice Address - Country:US
Practice Address - Phone:713-741-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC46391223G0001X
TX261371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice