Healthcare Provider Details

I. General information

NPI: 1437013851
Provider Name (Legal Business Name): RADIANT SMILES PEDIATRIC DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6519 STADIUM DR
ZEPHYRHILLS FL
33542-7567
US

IV. Provider business mailing address

6519 STADIUM DR
ZEPHYRHILLS FL
33542-7567
US

V. Phone/Fax

Practice location:
  • Phone: 813-328-3122
  • Fax: 813-328-3072
Mailing address:
  • Phone: 813-328-3122
  • Fax: 813-328-3072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN CLEOPHAS JOHNSON
Title or Position: OWNER
Credential: D.M.D.
Phone: 813-328-3122