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General NPI Number Information
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NPI Number | 1851559843
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Entity Type | Individual
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Provider Name | ERIC SCOTT JOHNSON DDS
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Gender | Male
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 04/30/2010
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Provider Practice Location Address
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Address Line | 647 CAMINO DE LOS MARES STE 209
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2807
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Country | US
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Telephone | 949-493-9311
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Fax |
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Provider Business Mailing Address
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Address Line | 647 CAMINO DE LOS MARES STE 209
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2807
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Country | US
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Telephone | 949-493-9311
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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 | 23846
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License Number State | TX
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