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General NPI Number Information
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NPI Number | 1174851596
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Entity Type | Individual
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Provider Name | JERROLD STUART JOHNSON DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 11/23/2009
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 3511 BUCKLIN HILL RD. NW
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City | SILVERDALE
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State | WA
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Zip | 98383
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Country | US
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Telephone | 360-337-2020
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Fax | 360-337-2021
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Provider Business Mailing Address
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Address Line | 3511 NW BUCKLIN HILL ROAD
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City | SILVERDALE
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State | WA
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Zip | 98383
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Country | US
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Telephone | 360-337-2020
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Fax | 360-337-2021
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DE00009912
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License Number State | WA
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