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General NPI Number Information
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NPI Number | 1477049500
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Entity Type | Individual
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Provider Name | BRANDON JOHNSON DMD
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Gender | Male
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Dates
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Enumeration Date | 07/01/2018
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Last Update Date | 08/16/2019
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Provider Practice Location Address
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Address Line | 15534 RANCH ROAD 620 N STE 300
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City | AUSTIN
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State | TX
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Zip | 78717-5277
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Country | US
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Telephone | 512-580-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 1033 ROBERTS BRANCH PKWY STE 103
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City | COLUMBIA
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State | SC
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Zip | 29203-9148
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Country | US
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Telephone | 803-339-8542
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9150
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 35499
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License Number State | TX
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