Provider Demographics
NPI:1457761983
Name:STEVEN G. JOHNSON DENTAL CORPORATION
Entity Type:Organization
Organization Name:STEVEN G. JOHNSON DENTAL CORPORATION
Other - Org Name:JOHNSON FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS SUPPORT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BUTTERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-456-1235
Mailing Address - Street 1:103 S MILLS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3456
Mailing Address - Country:US
Mailing Address - Phone:805-643-5026
Mailing Address - Fax:805-643-5029
Practice Address - Street 1:103 S MILLS RD STE 101
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3456
Practice Address - Country:US
Practice Address - Phone:805-643-5026
Practice Address - Fax:805-643-5029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty