Healthcare Provider Details

I. General information

NPI: 1700884384
Provider Name (Legal Business Name): JAMES H JOHNSON III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 CHESTERFIELD CIR
SAN MARCOS CA
92069-8103
US

IV. Provider business mailing address

535 CHESTERFIELD CIR
SAN MARCOS CA
92069-8103
US

V. Phone/Fax

Practice location:
  • Phone: 503-887-0334
  • Fax:
Mailing address:
  • Phone: 503-887-0334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7981
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: