Provider Demographics
NPI:1952562514
Name:JOHNSON, TREVOR GREGG (DMD)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:GREGG
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10350 FEDERAL BLVD UNIT 300
Mailing Address - Street 2:
Mailing Address - City:FEDERAL HEIGHTS
Mailing Address - State:CO
Mailing Address - Zip Code:80260-8616
Mailing Address - Country:US
Mailing Address - Phone:303-865-7550
Mailing Address - Fax:303-865-7551
Practice Address - Street 1:8700 W 101ST AVE STE 300
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021
Practice Address - Country:US
Practice Address - Phone:303-865-7550
Practice Address - Fax:303-865-7551
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO97011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery