Healthcare Provider Details

I. General information

NPI: 1295229722
Provider Name (Legal Business Name): DANIEL DARIUS JOHNSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 KITTY HAWK RD STE 130
UNIVERSAL CITY TX
78148-3964
US

IV. Provider business mailing address

6517 CROCKETT CV
SCHERTZ TX
78108-2043
US

V. Phone/Fax

Practice location:
  • Phone: 210-446-1498
  • Fax:
Mailing address:
  • Phone: 832-483-5762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number34018
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: