Provider Demographics
NPI:1801336433
Name:JOHNSON, JAYME JO (DMD)
Entity type:Individual
Prefix:
First Name:JAYME
Middle Name:JO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JAYME
Other - Middle Name:JO
Other - Last Name:NOESKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:414 E COTA ST FL 1
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1624
Mailing Address - Country:US
Mailing Address - Phone:805-617-7898
Mailing Address - Fax:805-617-7899
Practice Address - Street 1:164 KINMAN AVE
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-3481
Practice Address - Country:US
Practice Address - Phone:805-617-7898
Practice Address - Fax:805-617-7899
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND140111223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health