Provider Demographics
NPI:1669537767
Name:JOHNSON, ERIC OLIN (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:OLIN
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 1:4201 TORRANCE BLVD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4504
Mailing Address - Country:US
Mailing Address - Phone:310-540-8800
Mailing Address - Fax:310-540-8802
Practice Address - Street 1:4201 TORRANCE BLVD
Practice Address - Street 2:SUITE 420
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4504
Practice Address - Country:US
Practice Address - Phone:310-540-8800
Practice Address - Fax:310-540-8802
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34125122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist