Provider Demographics
NPI:1881967628
Name:JOHNSON IMPLANT DENTISRTY ASSOCIATES
Entity type:Organization
Organization Name:JOHNSON IMPLANT DENTISRTY ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MAXILLOFACIAL PROSTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARISTIDES
Authorized Official - Middle Name:A
Authorized Official - Last Name:TSIKOUDAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-739-6452
Mailing Address - Street 1:6460 MEDICAL CENTER ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2406
Mailing Address - Country:US
Mailing Address - Phone:702-739-6452
Mailing Address - Fax:702-739-6654
Practice Address - Street 1:6460 MEDICAL CENTER ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2406
Practice Address - Country:US
Practice Address - Phone:702-739-6452
Practice Address - Fax:702-739-6654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20002032901223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty