MEDICARE: DR. DAVID JAY JOHNSON DMD

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	1223P0221X	Pediatric Dentistry	4860276-8903	UT

General Provider Information

NPI Number	:	1831165224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JAY JOHNSON DMD

Provider Business Mailing Address
First Line	:	2364 W 12600 S
Second Line	:	STE 1-A
City	:	RIVERTON
State	:	UT
Zip	:	84065-7109
Country	:	US
Telephone Number	:	801-253-8866
Fax Number	:	801-253-8877

Provider Business Practice Location Address
First Line	:	2364 W 12600 S
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-7109
Country	:	US
Telephone Number	:	801-253-8866
Fax Number	:	801-253-8877

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	07/08/2007

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