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General NPI Number Information
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NPI Number | 1174509665
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Entity Type | Individual
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Provider Name | RICHARD LEE JOHNSON DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 82 MEDICAL GROUP/CREDENTIALS 149 HART STREET
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City | SHEPPARD AFB
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State | TX
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Zip | 76311-3482
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Country | US
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Telephone | 940-676-2003
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Fax |
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Provider Business Mailing Address
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Address Line | 5110 CROWN RIDGE DR
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City | WICHITA FALLS
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State | TX
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Zip | 76310-1768
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Country | US
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Telephone | 940-689-8896
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Fax |
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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 | DS0000005348
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | MD0000035690
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License Number State | TN
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