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General NPI Number Information
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NPI Number | 1346903499
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Entity Type | Organization
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Legal Business Name | JOHNSON ELITE SMILE GROUP, PLLC
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Dates
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Enumeration Date | 10/15/2021
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 8500 CYPRESSWOOD DR STE 204
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City | SPRING
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State | TX
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Zip | 77379-7109
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Country | US
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Telephone | 281-501-3001
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Fax |
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Provider Business Mailing Address
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Address Line | 3702 COPPERCREST DR
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City | BRYAN
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State | TX
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Zip | 77802-5941
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Country | US
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Telephone | 979-774-7500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN ALBERT JOHNSON JR.
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Credential | D.D.S.
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Telephone | 979-774-7500
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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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