Healthcare Provider Details

I. General information

NPI: 1821355298
Provider Name (Legal Business Name): JOHNSON DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N LA CUMBRE RD STE H
SANTA BARBARA CA
93110-1577
US

IV. Provider business mailing address

200 N LA CUMBRE RD STE H
SANTA BARBARA CA
93110-1577
US

V. Phone/Fax

Practice location:
  • Phone: 805-960-5600
  • Fax: 805-682-8899
Mailing address:
  • Phone: 805-960-5600
  • Fax: 805-682-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number53046
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number60946
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY JULIA MADDEN
Title or Position: OPERATIONS MANAGER
Credential: RDA
Phone: 805-682-4800