Healthcare Provider Details

I. General information

NPI: 1770403768
Provider Name (Legal Business Name): LANCE JOHNSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N MAIN ST
ELBURN IL
60119-9162
US

IV. Provider business mailing address

9N766 WHISPERING SPRINGS LN
ELGIN IL
60124-8362
US

V. Phone/Fax

Practice location:
  • Phone: 630-931-0183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019037328
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: