Provider Demographics
NPI:1801198551
Name:JAMES D JOHNSON DDS PC
Entity type:Organization
Organization Name:JAMES D JOHNSON DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-253-0595
Mailing Address - Street 1:2651 W 10400 S
Mailing Address - Street 2:STE 202
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8953
Mailing Address - Country:US
Mailing Address - Phone:801-253-0595
Mailing Address - Fax:801-253-0758
Practice Address - Street 1:2651 W 10400 S
Practice Address - Street 2:STE 202
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8953
Practice Address - Country:US
Practice Address - Phone:801-253-0595
Practice Address - Fax:801-253-0758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2960149922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty