Provider Demographics
NPI:1740481589
Name:JOHNSON, DARRYL KEITH (DDS)
Entity type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:KEITH
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 1:1011 SAINT ANDREWS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4248
Mailing Address - Country:US
Mailing Address - Phone:916-933-0532
Mailing Address - Fax:
Practice Address - Street 1:1011 SAINT ANDREWS DR
Practice Address - Street 2:SUITE B
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4248
Practice Address - Country:US
Practice Address - Phone:916-933-0532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA379801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics