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General NPI Number Information
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NPI Number | 1376766345
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Entity Type | Organization
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Legal Business Name | BRUCE W. JOHNSON, D.M.D., APDC
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 15708 POMERADO ROAD SUITE N104
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City | POWAY
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State | CA
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Zip | 92064
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Country | US
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Telephone | 858-485-1180
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Fax |
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Provider Business Mailing Address
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Address Line | 15708 POMERADO ROAD SUITE N104
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City | POWAY
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State | CA
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Zip | 92064
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Country | US
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Telephone | 858-485-1180
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Fax | 858-485-1426
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Authorized Official
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Title or Position | DMD/OWNER
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Name | DR. BRUCE W JOHNSON
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Credential | DMD
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Telephone | 858-485-1180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 29312
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License Number State | PA
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