Healthcare Provider Details

I. General information

NPI: 1023894326
Provider Name (Legal Business Name): NEAL A JOHNSON DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34366 YUCAIPA BLVD STE K
YUCAIPA CA
92399-2497
US

IV. Provider business mailing address

34366 YUCAIPA BLVD STE K
YUCAIPA CA
92399-2497
US

V. Phone/Fax

Practice location:
  • Phone: 909-754-5659
  • Fax:
Mailing address:
  • Phone: 909-797-9247
  • Fax: 909-354-3767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State

VIII. Authorized Official

Name: DR. NEAL ANTONIO JOHNSON
Title or Position: OWNER
Credential: DDS
Phone: 909-754-5659