MEDICARE: TALIAH J 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	4639	SC
2	1223G0001X	General Practice Dentistry	26137	TX

General Provider Information

NPI Number	:	1457580342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALIAH J JOHNSON (DDS)

Provider Business Mailing Address
First Line	:	6120 SCOTT ST STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77021-2698
Country	:	US
Telephone Number	:	713-741-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6120 SCOTT ST STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77021-2698
Country	:	US
Telephone Number	:	713-741-1000
Fax Number	:

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

Provider Enumeration Date	:	07/13/2009
Last Update Date	:	02/18/2011

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