Healthcare Provider Details

I. General information

NPI: 1942303300
Provider Name (Legal Business Name): CURTIS M JOHNSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

94-01 ASTORIA BLVD
EAST ELMHURST NY
11369-1534
US

IV. Provider business mailing address

94-01 ASTORIA BLVD
EAST ELMHURST NY
11369-1534
US

V. Phone/Fax

Practice location:
  • Phone: 718-639-6550
  • Fax: 718-429-2717
Mailing address:
  • Phone: 718-639-6550
  • Fax: 718-429-2717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number035175
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: