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General NPI Number Information
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NPI Number | 1427598341
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Entity Type | Individual
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Provider Name | JOHNNY D HUYNH DDS
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Gender | Male
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Dates
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Enumeration Date | 02/24/2017
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 260 LAMP AND LANTERN VLG
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City | TOWN AND COUNTRY
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State | MO
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Zip | 63017-8209
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Country | US
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Telephone | 362-203-5536
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Fax |
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Provider Business Mailing Address
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Address Line | 3853 FOREST PARK AVE APT 116A
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City | SAINT LOUIS
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State | MO
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Zip | 63108-3352
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Country | US
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Telephone | 714-603-5164
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2019000689
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 2019000689
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License Number State | MO
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