Healthcare Provider Details

I. General information

NPI: 1376788489
Provider Name (Legal Business Name): RICHARD A JOHNSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CALLE DE LAS TIENDAS STE 125B
GREEN VALLEY AZ
85614
US

IV. Provider business mailing address

75 CALLE DE LAS TIENDAS STE 125B
GREEN VALLEY AZ
85614
US

V. Phone/Fax

Practice location:
  • Phone: 520-399-4000
  • Fax: 520-296-0558
Mailing address:
  • Phone: 520-399-4000
  • Fax: 520-296-0558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4676
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: