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General NPI Number Information
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NPI Number | 1265260731
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Entity Type | Organization
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Legal Business Name | SHEVANTHI JOHNSON DDS PC
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Dates
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Enumeration Date | 07/25/2024
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 11285 MOUNTAIN VIEW AVE STE H-32
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City | LOMA LINDA
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State | CA
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Zip | 92354-3811
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Country | US
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Telephone | 909-796-6447
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Fax |
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Provider Business Mailing Address
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Address Line | 11285 MOUNTAIN VIEW AVE STE H-32
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City | LOMA LINDA
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State | CA
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Zip | 92354-3811
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DDS
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Name | SHEVANTHI JOHNSON
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Credential |
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Telephone | 619-727-3444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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