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NPI Code Detail

MEDICARE: BRADLEY SCOTT JOHNSON DMD

MEDICARE: BRADLEY SCOTT JOHNSON DMD
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
11223G0001XGeneral Practice Dentistry9917SC
2122300000XDentist38896TX

General Provider Information

NPI Number : 1407427024
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY SCOTT JOHNSON DMD
Provider Business Mailing Address
First Line : 2901 CASSIDY RD
Second Line :
City : EL PASO
State : TX
Zip : 79916-3502
Country : US
Telephone Number : 915-742-6072
Fax Number :
Provider Business Practice Location Address
First Line : 2901 CASSIDY RD
Second Line :
City : EL PASO
State : TX
Zip : 79916-3502
Country : US
Telephone Number : 915-742-6072
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2021
Last Update Date : 04/11/2023

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Directions to “ BRADLEY SCOTT JOHNSON DMD” Practice Location

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