Healthcare Provider Details

I. General information

NPI: 1457570319
Provider Name (Legal Business Name): JAY A JOHNSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 NORTH BRONCO ST SUITE 102
LAS VEGAS NV
89108-4863
US

IV. Provider business mailing address

3220 NORTH BRONCO ST SUITE 102
LAS VEGAS NV
89108-4863
US

V. Phone/Fax

Practice location:
  • Phone: 702-396-2223
  • Fax: 702-396-7805
Mailing address:
  • Phone: 702-396-2223
  • Fax: 702-396-7805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2320
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: