Healthcare Provider Details

I. General information

NPI: 1134431729
Provider Name (Legal Business Name): ANDREA LYNN JOHNSON D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 W RAY RD STE 3
CHANDLER AZ
85224-3549
US

IV. Provider business mailing address

18121 E VENCINO ST
GILBERT AZ
85298-9201
US

V. Phone/Fax

Practice location:
  • Phone: 602-369-3281
  • Fax:
Mailing address:
  • Phone: 602-369-3281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2076
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD008666
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: