Healthcare Provider Details

I. General information

NPI: 1831165224
Provider Name (Legal Business Name): DAVID JAY JOHNSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2364 W 12600 S
RIVERTON UT
84065-7109
US

IV. Provider business mailing address

2364 W 12600 S STE 1-A
RIVERTON UT
84065-7109
US

V. Phone/Fax

Practice location:
  • Phone: 801-253-8866
  • Fax: 801-253-8877
Mailing address:
  • Phone: 801-253-8866
  • Fax: 801-253-8877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4860276-8903
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: