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General NPI Number Information
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NPI Number | 1164639167
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Entity Type | Individual
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Provider Name | DANIEL P. JOHNSON DDS, PC
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 630 15TH AVE STE 101
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City | LONGMONT
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State | CO
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Zip | 80501-2700
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Country | US
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Telephone | 303-485-0300
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Fax | 303-485-0777
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Provider Business Mailing Address
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Address Line | 630 15TH AVE STE 101
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City | LONGMONT
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State | CO
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Zip | 80501-2700
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Country | US
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Telephone | 303-485-0300
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Fax | 303-485-0777
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 7778
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License Number State | CO
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