MEDICARE: SCOTT S. JOHNSON D.D.S., PLLC

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	305S00000X	Point of Service	6594	CO

General Provider Information

NPI Number	:	1396125779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT S. JOHNSON D.D.S., PLLC

Provider Business Mailing Address
First Line	:	7325 S PIERCE ST
Second Line	:	SUITE 104
City	:	LITTLETON
State	:	CO
Zip	:	80128-4553
Country	:	US
Telephone Number	:	303-979-0229
Fax Number	:	303-979-1514

Provider Business Practice Location Address
First Line	:	7325 S PIERCE ST
Second Line	:	SUITE 104
City	:	LITTLETON
State	:	CO
Zip	:	80128-4553
Country	:	US
Telephone Number	:	303-979-0229
Fax Number	:	303-979-1514

Authorized Official
Title or Position	:	OWNER/DR
Name	:	SCOTT STOLLE JOHNSON
Credential	:	D.D.S.
Telephone Number	:	303-979-0229

Provider Enumeration Date	:	06/01/2015
Last Update Date	:	06/01/2015

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