Provider Demographics
NPI:1750350195
Name:JOHNSON, GARY LEONARD JR (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEONARD
Last Name:JOHNSON
Suffix:JR
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 1:2730 COHASSET RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0977
Mailing Address - Country:US
Mailing Address - Phone:530-343-5587
Mailing Address - Fax:530-343-5824
Practice Address - Street 1:2730 COHASSET RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-0977
Practice Address - Country:US
Practice Address - Phone:530-343-5587
Practice Address - Fax:530-343-5824
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist