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General NPI Number Information
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NPI Number | 1801198551
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Entity Type | Organization
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Legal Business Name | JAMES D JOHNSON DDS PC
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Dates
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Enumeration Date | 12/01/2010
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 2651 W 10400 S STE 202
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-8953
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Country | US
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Telephone | 801-253-0595
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Fax | 801-253-0758
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Provider Business Mailing Address
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Address Line | 2651 W 10400 S STE 202
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-8953
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Country | US
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Telephone | 801-253-0595
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Fax | 801-253-0758
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Authorized Official
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Title or Position | CEO
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Name | DR. JAMES DOUGLAS JOHNSON
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Credential | DDS
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Telephone | 801-253-0595
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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 | 2960149922
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License Number State | UT
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