Provider Demographics
NPI:1811303555
Name:JOHNSON, BETTY MARLEENA (DDS)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:MARLEENA
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 1:707 E OCEAN BLVD
Mailing Address - Street 2:APT 516
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802
Mailing Address - Country:US
Mailing Address - Phone:601-940-6593
Mailing Address - Fax:
Practice Address - Street 1:1000 W CARSON STREET
Practice Address - Street 2:BOX 19
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90502
Practice Address - Country:US
Practice Address - Phone:310-668-4202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA649691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice