Provider Demographics
NPI:1770892838
Name:JOHNSON, SHERIN (DDS)
Entity type:Individual
Prefix:DR
First Name:SHERIN
Middle Name:
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 1:10343 SAN DIEGO MISSION RD
Mailing Address - Street 2:#246D
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2172
Mailing Address - Country:US
Mailing Address - Phone:619-917-1433
Mailing Address - Fax:
Practice Address - Street 1:10343 SAN DIEGO MISSION RD
Practice Address - Street 2:#246D
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2172
Practice Address - Country:US
Practice Address - Phone:619-917-1433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA598891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice