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General NPI Number Information
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NPI Number | 1275332926
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Entity Type | Organization
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Legal Business Name | JOHNSON DENTAL PARTNERS SOUTH LLC
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 101 S LA CANADA DR STE 54
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City | GREEN VALLEY
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State | AZ
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Zip | 85614-2664
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Country | US
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Telephone | 520-625-2311
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Fax |
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Provider Business Mailing Address
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Address Line | 101 S LA CANADA DR STE 54
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City | GREEN VALLEY
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State | AZ
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Zip | 85614-2664
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Country | US
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Telephone | 520-625-2311
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Fax |
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Authorized Official
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Title or Position | RECEPT
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Name | HOLLY ALEXANDER
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Credential |
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Telephone | 520-625-2311
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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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