Provider Demographics
NPI:1841641453
Name:JOHNSON, DAMILOLA (DDS)
Entity type:Individual
Prefix:DR
First Name:DAMILOLA
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 1:190 E STACY RD STE 314
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8738
Mailing Address - Country:US
Mailing Address - Phone:972-678-1277
Mailing Address - Fax:
Practice Address - Street 1:190 E STACY RD STE 314
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8738
Practice Address - Country:US
Practice Address - Phone:972-678-1277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6839122300000X
TX33495122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist