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General NPI Number Information
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NPI Number | 1629601679
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Entity Type | Individual
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Provider Name | ROBERT JACKSON JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 150 55TH ST
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City | BROOKLYN
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State | NY
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Zip | 11220-2508
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Country | US
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Telephone | 718-630-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 947 N 50 E
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City | KAYSVILLE
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State | UT
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Zip | 84037-1203
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Country | US
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Telephone |
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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 | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 4405-23
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | D012025
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 11770
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License Number State | TN
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