MEDICARE: DR. PAUL MICHAEL 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	1223G0001X	General Practice Dentistry	19908	CA

General Provider Information

NPI Number	:	1336257856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL MICHAEL JOHNSON D.D.S.

Provider Business Mailing Address
First Line	:	360 SAN MIGUEL DR STE 602
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7832
Country	:	US
Telephone Number	:	949-640-0300
Fax Number	:	949-640-5412

Provider Business Practice Location Address
First Line	:	360 SAN MIGUEL DR STE 602
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7832
Country	:	US
Telephone Number	:	949-640-0300
Fax Number	:	949-640-5412

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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