Healthcare Provider Details

I. General information

NPI: 1841427846
Provider Name (Legal Business Name): SPENCER E JOHNSON DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2453 E 3300 S STE 201
SALT LAKE CITY UT
84109-2725
US

IV. Provider business mailing address

2453 E 3300 S STE 201
SALT LAKE CITY UT
84109-2725
US

V. Phone/Fax

Practice location:
  • Phone: 801-466-0040
  • Fax: 801-463-0481
Mailing address:
  • Phone: 801-466-0040
  • Fax: 801-463-0481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number78439839921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: