Healthcare Provider Details

I. General information

NPI: 1194686717
Provider Name (Legal Business Name): PRECIOUS JOHNSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701A S HARVARD AVE # 177
TULSA OK
74135-2282
US

IV. Provider business mailing address

3701A S HARVARD AVE # 177
TULSA OK
74135-2282
US

V. Phone/Fax

Practice location:
  • Phone: 405-497-5861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDB-2026-0168
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8038
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: