MEDICARE: DR. DARRYL KEITH 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	37980	CA

General Provider Information

NPI Number	:	1740481589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARRYL KEITH JOHNSON DDS

Provider Business Mailing Address
First Line	:	1011 SAINT ANDREWS DR
Second Line	:	SUITE B
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-4248
Country	:	US
Telephone Number	:	916-933-0532
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 SAINT ANDREWS DR
Second Line	:	SUITE B
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-4248
Country	:	US
Telephone Number	:	916-933-0532
Fax Number	:

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/08/2007

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