MEDICARE: DR. RYAN MAX JOHNSON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	22989	TX
2	1223G0001X	General Practice Dentistry	22989	TX
3	122300000X	Dentist	22989	TX
4	1223G0001X	General Practice Dentistry	5948521-9922	UT

General Provider Information

NPI Number	:	1336190099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN MAX JOHNSON D.D.S.

Provider Business Mailing Address
First Line	:	113 SCENIC RIDGE DR
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76087-1522
Country	:	US
Telephone Number	:	702-299-5821
Fax Number	:

Provider Business Practice Location Address
First Line	:	7451 N BEACH ST STE 140
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-5160
Country	:	US
Telephone Number	:	817-847-7001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	06/10/2024

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