MEDICARE: PHILIP S JOHNSON DDS PC

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

General Provider Information

NPI Number	:	1932313640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILIP S JOHNSON DDS PC

Provider Business Mailing Address
First Line	:	4025 W BELL RD
Second Line	:	7
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2750
Country	:	US
Telephone Number	:	602-862-0967
Fax Number	:

Provider Business Practice Location Address
First Line	:	4025 W BELL RD
Second Line	:	7
City	:	PHOENIX
State	:	AZ
Zip	:	85053-2750
Country	:	US
Telephone Number	:	602-862-0967
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PHILIP S JOHNSON
Credential	:
Telephone Number	:	602-862-0967

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	11/27/2012

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