MEDICARE: JOLLY SAMUEL JOHNSON DDS

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	9112	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407908742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOLLY SAMUEL JOHNSON DDS

Provider Business Mailing Address
First Line	:	2132 E HARMONY RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-9504
Country	:	US
Telephone Number	:	970-287-3701
Fax Number	:	970-287-3702

Provider Business Practice Location Address
First Line	:	2132 E HARMONY RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-9504
Country	:	US
Telephone Number	:	970-287-3701
Fax Number	:	970-287-3702

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	11/02/2020

Similar Medicare Providers

1700379666 — DR. PRESTON FORD GRAY DDS
Practice Location Address:

2132 E HARMONY RD
FORT COLLINS, CO
80528-9504

Practice Phone: 970-287-3701
Practice Fax:

1285235846 — HARMONY DENTAL PARTNERS LLP
Practice Location Address:

2132 E HARMONY RD
FORT COLLINS, CO
80528-9504

Practice Phone: 970-287-3701
Practice Fax: 970-287-3702

1114203734 — MS. TAMARA ANTONIA STOJADINOVIC M.A. RYT.
Practice Location Address:

9504 WATERCRESS DR
FORT WORTH, TX
76135-4906

Practice Phone: 817-984-9642
Practice Fax:

1194436691 — JULIE DRUCKER MT
Practice Location Address:

31421 AIRPORT RD
FORT BRAGG, CA
95437-9504

Practice Phone: 707-513-7397
Practice Fax:

1346072881 — DEVIN ROSE MARONEY
Practice Location Address:

2121 E HARMONY RD UNIT 310
FORT COLLINS, CO
80528-3403

Practice Phone: 970-221-3855
Practice Fax: 970-212-1238

1225985096 — MRS. ANGELA RANAE DAVIS LMT
Practice Location Address:

6232 FALL HARVEST WAY
FORT COLLINS, CO
80528-7242

Practice Phone: 310-999-1804
Practice Fax:

Directions to “ JOLLY SAMUEL JOHNSON DDS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.