MEDICARE: JAY A JOHNSON DDS LTD

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	122300000X	Dentist	2320	NV

General Provider Information

NPI Number	:	1639398597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY A JOHNSON DDS LTD

Provider Business Mailing Address
First Line	:	3220 N BRONCO ST
Second Line	:	STE 102
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4863
Country	:	US
Telephone Number	:	702-396-2223
Fax Number	:	702-396-7805

Provider Business Practice Location Address
First Line	:	3220 N BRONCO ST
Second Line	:	STE 102
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4863
Country	:	US
Telephone Number	:	702-396-2223
Fax Number	:	702-396-7805

Authorized Official
Title or Position	:	OWNER
Name	:	JAY A JOHNSON
Credential	:	DDS
Telephone Number	:	70239622223

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/22/2020

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