MEDICARE: STEVEN G. JOHNSON DENTAL CORPORATION

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
2	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	42163	OTHER	CA	CALIFORNIA DENTAL LICENSE

General Provider Information

NPI Number	:	1770975492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN G. JOHNSON DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	5800 SANTA ROSA RD
Second Line	:	SUITE 101
City	:	CAMARILLO
State	:	CA
Zip	:	93012-7056
Country	:	US
Telephone Number	:	805-987-8782
Fax Number	:	805-987-5649

Provider Business Practice Location Address
First Line	:	5800 SANTA ROSA RD
Second Line	:	SUITE 101
City	:	CAMARILLO
State	:	CA
Zip	:	93012-7056
Country	:	US
Telephone Number	:	805-987-8782
Fax Number	:	805-987-5649

Authorized Official
Title or Position	:	OPERATIONS SUPPORT MANAGER
Name	:	MS. AMY LOUISE BUTTERY
Credential	:
Telephone Number	:	805-456-1235

Provider Enumeration Date	:	03/04/2015
Last Update Date	:	01/04/2021

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Directions to “STEVEN G. JOHNSON DENTAL CORPORATION ” Practice Location

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