Healthcare Provider Details

I. General information

NPI: 1861441503
Provider Name (Legal Business Name): ARTHUR DOUGLAS JOHNSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 W. BUENA VISTA RD. SUITE 206
EVANSVILLE IN
47710-5185
US

IV. Provider business mailing address

1202 W BUENA VISTA RD
EVANSVILLE IN
47710-5185
US

V. Phone/Fax

Practice location:
  • Phone: 812-422-2444
  • Fax: 812-429-1529
Mailing address:
  • Phone: 812-422-2444
  • Fax: 812-429-1529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12007699A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: