Provider Demographics
NPI:1932377504
Name:JOHNSON, LAERROL TERRELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAERROL
Middle Name:TERRELL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14626 BELLAIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083
Mailing Address - Country:US
Mailing Address - Phone:281-491-4545
Mailing Address - Fax:281-491-7134
Practice Address - Street 1:14626 BELLAIRE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083
Practice Address - Country:US
Practice Address - Phone:281-491-4545
Practice Address - Fax:281-491-7134
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3376857Medicaid