Provider Demographics
NPI:1770975492
Name:STEVEN G. JOHNSON DENTAL CORPORATION
Entity type:Organization
Organization Name:STEVEN G. JOHNSON DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:5800 SANTA ROSA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-7056
Mailing Address - Country:US
Mailing Address - Phone:805-987-8782
Mailing Address - Fax:805-987-5649
Practice Address - Street 1:5800 SANTA ROSA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-7056
Practice Address - Country:US
Practice Address - Phone:805-987-8782
Practice Address - Fax:805-987-5649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA42163OtherCALIFORNIA DENTAL LICENSE