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General NPI Number Information
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NPI Number | 1114343191
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Entity Type | Individual
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Provider Name | PEGGY JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 03/13/2014
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Last Update Date | 03/13/2014
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Provider Practice Location Address
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Address Line | 437 OLD VIA RANCHO DR
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City | ESCONDIDO
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State | CA
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Zip | 92029-7959
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Country | US
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Telephone | 760-638-2477
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Fax | 760-745-0828
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Provider Business Mailing Address
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Address Line | 437 OLD VIA RANCHO DR
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City | ESCONDIDO
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State | CA
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Zip | 92029-7959
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Country | US
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Telephone | 760-638-2477
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Fax | 760-745-0828
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 452
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 10008
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License Number State | CA
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